Diagnosis and management of colonic injuries following blunt trauma

Abstract

AIM:To retrospectively evaluate the preoperative diagnostic approaches and management of colonic injuries following blunt abdominal trauma. METHODS:A total of 82 patients with colonic injuries caused by blunt trauma between January 1992 and December 2005 were enrolled. Data were collected on clinical presentation, investigations, diagnostic methods, associated injuries, and operative management. Colonic injury-related mortality and abdominal complications were analyzed. RESULTS:Colonic injuries were caused mainly by motor vehicle accidents. Of the 82 patients, 58 (70.3%) had other associated injuries. Laparotomy was performed within 6 h after injury in 69 cases (84.1%), laparoscopy in 3 because of haemodynamic instability. The most commonly injured site was located in the transverse colon. The mean colon injury scale score was 2.8. The degree of faecal contamination was classified as mild in 18 (22.0%), moderate in 42 (51.2%), severe in 14 (17.1%), and unknown in 8 (9.8%) cases. Sixty-seven patients (81.7%) were treated with primary repair or resection and anastomosis. Faecal stream diversion was performed in 15 cases (18.3%). The overall mortality rate was 6.1%. The incidence of colonic injuryrelated abdominal complications was 20.7%. The only independent predictor of complications was the degree of peritoneal faecal contamination (P = 0.02). CONCLUSION:Colonic injuries following blunt trauma are especially important because of the severity and complexity of associated injuries. A thorough physical examination and a combination of tests can be used to evaluate the indications for laparotomy. One stage management at the time of initial exploration is most often used for colonic injuries.

Primary Repair of Traumatic Gut Injury Without Diversion in Casualty Department of Dhaka Medical College Hospital

“…Bhatti et al recommended primary repair for the management of penetrating colonic injury because of its better outcome in terms of less infection and early recovery 4 . Zheng et al treated 81.7% patients with primary repair with 16% would infection 9 . Naraynsingh et al found 10% wound infection rate in their study to support the view of primary repair of colon to be the management of choice 11 .…”

“…Colon is one of the most commonly injured viscera followed by small gut and liver in abdomen for which management becomes complicated had the type and severity of injury not been assessed properly 4,5 . In primary repair of wound, researchers used several options of primary repair with or without colostomy to check the effectiveness of repair without diversion [6][7][8][9][10][11][12][13][14] . Similar types of intervention had been adopted in developing countries too [15][16] .…”

The influence of the risk factor on the abdominal complications in colon injury management

“…Zhang YX et al (14) in their retrospective study reported the degree of peritoneal fecal contamination as the only independent predictor of complications. The location of the colon injury as an important risk factors for anastomotic leak is controversial.…”

Intestinal Injury from Blunt Abdominal Trauma: A Study of 47 Cases

“…A positive test is defined as evidence of free fluid or solid organ parenchymal injury. 16 DPL was the diagnostic method of choice for evaluating blunt abdominal injury in the past, but recently has been often replaced by CT imaging. 17 DPL is an important adjunct in cases where bowel injury is suspected.…”