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Chirurgia 1999 June;12(3):199-204


language: Italian

Surgical treatment of blunt and penetrating colon injuries

Ialongo P., Chiriatti G., Azzolini F., Calò D.


Background. Surgical treatment of traumatic colon injuries is still debated. During last years in the USA and western countries the primary repair with or without resection has gained consensus in relation to diversion (colostomy or exteriorization). Personal experience in surgical treatment of blunt and penetrating colon injuries is retrospectively analyzed.
Methods. Between January 1988 and April 1998 at the General Surgery Department of Mesagne Hospital before and then of Brindisi Hospital, 74 patients were operated on for traumatic colon injuries. There were 61 men and 13 women with a median age of 49 years (range 14-75). As to etiology, there were 54 (72,9%) open injuries (16 consequent to wound by weapons and 38 by fire) and 20 (27,1%) blunt trauma (5 by foreign body ingestion and 15 by iatrogenic causes). Forty-three patients (58,1%) had primary repair and 20 (27%) resection with anastomosis. In 11 patients (14,9%) with extra-peritoneal rectal perforations or heavy contamination a colostomy was performed.
Results. Three patients occurred late at our observation with important fecal contamination died in intensive unit for sepsis. The overall mortality rate for the series was 4% and particularly 1.6% in the case of primary repair and 18.2% in the case of colonic diversion (p<0.01). The overall morbidity rate was 17.55%. Total hospitalization, considered without patients dead, was 24.9±18.5.
Conclusions. Primary repair with or without resection must be considered the ''gold standard'' in surgical management of traumatic colon injuries. Otherwise colonic diversion is the treatment of choice in the case of high-risk situations and of anal trauma. In fact, in presence of associated organ injuries, of massive blood transfusions and of pre-existing medical illness, the risk of anastomotic dehiscence is high. The poor consistence of the sample of patients who underwent an operation of colonic diversion and the grater seriousness of colon injuries (according to the classification of Flint et al.) in this sample don't allow to get statistically valid conclusions and to declare the priority of a surgical strategy. At any way the low overall mortality rate (4%) permits to consider favourably this trend and to persist in this strategy.

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