Over the past three decades, primary repair of colonic injuries has
become more accepted and there has been a trend toward using this procedure for
repairing civilian colonic injures. However, the best procedure remains controversial.
Forty patients with colonic injuries alone or associated with other organ injuries were
included in the present study over a 57-month period at Banha University Hospital.
After resuscitation, exploratory laparotomy was done and other organ injuries were
appropriately managed. Colonic injuries were dealt with either by primary repair or
diversion according to the risk factors affecting the outcome (Shock, degree of faecal
contamination, associated organ injuries, delay in repair, age, blood transfusion,
mechanism and site of injury and injury severity indices). The mechanism of injury
was stab injury in 37.5%, gunshot in 32.5%, iatrogenic in 17% and blunt trauma in
12% .Isolated colon injuries were found in 27.5% and associated with small in
testinal injury in 47%.The left colon injuries were found in 40% followed by
transverse colon in 37.5% .Primary repair, either by debridement and simple closure
in 2 layers or by segmental resection and primary anastomosis was done in 65% of
patients while diversion procedures were carried out for 35% of patients. There were
3 mortalities (7.5%) and complications occurred in 30% of the studied patients .
From this study we can conclude that there is no single policy for management
of colon injuries either by diversion or primary repair. Good results can be obtained
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by proper decision of an experienced surgeon according to the individual
circumstances of each case rather than following solid scheme by less experienced
surgeon. Primary suture should be limited to early cases induced by sharp agents or
iatrogenic injury. For most severely traumatized patients diversion remains the most
dependable method of treatment as it is followed by the least morbidity and mortality |
