Penetrating Injuries to the Colon and Rectum

Abstract

The management of colon and rectal injuries has evolved greatly over the last several decades. Once known to have significant mortality, the implementation of mandatory diversion in the 1940s drastically improved outcomes. Since then, treatment strategies have now shifted towards primary repair as a safe option for the majority of injuries. When wounds are more destructive, resection and primary anastomosis are usually appropriate in most situations. Management of penetrating colon injuries is more complex in the setting of damage control surgery and may require difficult decisions regarding timing of anastomosis. Rectal injuries were also historically known to have significant morbidity until diversion was implemented. Extraperitoneal injuries are still treated in a similar fashion, while intraperitoneal injuries are managed using the same principles as colon injuries. This article will review the management of penetrating colon and rectal injuries with focus on literature that has been published over the last 3 years.

Laparoscopic treatment for colonic injuries following penetrating trauma: A feasible option in a surgical department of Sub-Saharan Africa

“…Firstly, there are non-destructive lesions (interesting less than 50 % of the circumference without meso vascular lesion); and secondly, destructive lesions involving more than 50 % of the circumference with meso vascular lesion [2] . Non-destructive lesions are treated by primary suture and destructive ones by resection followed by anastomosis or stoma [2] , [13] . In our patients, since lesions were classified Grade II, the primary suture was performed with good evolution.…”

Anorectal injury related to a personal watercraft: a case report and literature review

“…Previous studies have reported that primary repair or resection and primary anastomosis should be performed for colonic and intraperitoneal rectal injuries when there is no major physiologic abnormality [15]. For extraperitoneal rectal injuries, primary repair with or without diversion is the mainstay of treatment, but colostomy alone without repair may be considered for injuries that are technically difficult to access [15,16]. However, in cases of anorectal injuries related to PWC use, as shown in Table 1, the lesions are complex and can occur in multiple locations and in a widespread area.…”

Autotransplantation of autologous adipose tissue‐derived mesenchymal stem cells to treat complex fistula‐in‐ano – the FLiRT technique ‐ a video vignette

“…For patients in whom an ileostomy alone is inadequate or inappropriate, pouch excision is required [1]. Most surgeons rarely perform this difficult operation but the high volume at St Mark's has led to the development of a reproducible, stepwise approach (Video S1) [2].…”

“…A balance between healing, recurrence and continence-preservation rates should be maintained, which appears to be difficult in complex FIA (such as recurrent, high trans-sphincteric, anterior fistulas in women, fistulas with multiple tracts and fistulas in patients with Crohn's disease) [1]. There is a paradigm shift towards sphincter-saving interventions, such as ligation intersphincteric fistulous tract, video-assisted anal fistula treatment and fistula laser closure, which give promising, easily reproducible results [2,3]. Furthermore, the use of biomaterials, in particular, human mesenchymal stem cells (MSCs) has received widespread attention [4].…”

“…Dear Sir, Rectal injuries are rare but may have a high overall complication rate. The incidence of colorectal injuries in the civilian literature is 1-3% [1,2]. Laparotomy has been the main surgical approach for treatment of rectal injury due to its advantages such as adequate localization of perforations and the possibility for peritoneal lavage.…”