The present role of colostomy in the management of trauma

Abstract

The role of colostomy in the treatment of abdominal trauma has changed over the past several decades. Primarily as a result of its successful use in military settings, colostomy initially was the mainstay of treatment for penetrating injury to the colon, rectal injury, and some forms of blunt trauma. Subsequent civilian experience with the techniques of primary repair of penetrating colon injury resulted in a decrease in the number of colostomies performed. Coupled with this experience, early data on adverse outcome from colostomy closure tended to support the trend of the ever-diminishing place of colostomy for trauma. Colostomy has always been used for two purposes in trauma care: prevention or arrest of fecal contamination of the peritoneal cavity and diversion of the fecal stream. Despite the decreased need for colostomy in some forms of penetrating colon injury, there are several conditions that still utilize colostomy to accomplish one or both of these purposes. Indications for colostomy can now be regarded as absolute or relative depending upon the need for diversion or the requirement to prevent contamination. There are relatively few contraindications to colostomy use. Present results of colostomy closure do not represent excessive risk to the patient and should not impact negatively on the decision to perform a colostomy for trauma.

Delayed colostomy closure using the extraperitoneal method

“…The average was 46 years, in agreement with various authors [3][4][5]. As for the colorectal traumas, studies support the primary closure of colon wounds, when lesions are small and the patient's hemodynamic condition is stable [6][7][8][9][10].…”

Survival following an impalement injury through the perineum in association with high voltage electrical burns: A case report

“…Diverting colostomy has been the standard for anorectal injuries and bowel injuries [6][7][8][9]. The use of suprapubic catheterization for bladder repair is shifting more towards transurethral route even in the face of intraperitoneal bladder injury [10][11][12].…”

Colon and Rectal Injuries

“…41 Colostomy was mandatory in the treatment of colon injuries during World War II, with a reported decrease in mortality from 60 to 30 percent. 38,[43][44][45] However, septic complications, including wound infections, intra-abdominal abscess, evisceration, or colostomy retraction, occurred in nearly all patients. In 1951, Woodhall and Oschner 46 challenged the colostomy ultimatum mandated during World War II, emphasizing the difference between high-velocity devitalizing military injuries and low-velocity civilian gunshot wounds.…”

“…Injuries include serosal tears, contusion injuries, and devascularization injuries with or without associated colonic disruption, all a result of major energy transfer. 44 Disruption of intestinal mesentery may lead to ischemia of the involved bowel segment. Of these injuries, 75 to 90 percent are the result of motor vehicle accidents with high-energy transfer necessary to cause injury to mobile, hollow organs.…”

“…The number of associated injuries and PATI have been linked with infectious and noninfectious complications but not suture line dehiscence. [43][44][45]53,56,61,68,70,71,74,[76][77][78][79]81,[84][85][86][87][88][89] Indications for primary repair after transfusion are unclear. Several retrospective studies of combined destructive and nondestructive injuries demonstrate increased risk for septic complications after blood transfusions.…”