Traumatic Injury of the Colon and Rectum: The Evidence vs Dogma

Not all intestinal traumatic injuries are the same: A comparison of surgically treated blunt vs. penetrating injuries

“…A major source for such morbidity is sepsis related consequences of intestinal leak and associated wound complications [7][8][9][10]. Anastomotic failures are a well-established source of morbidity in intestinal injuries; however the universal pathogenesis behind anastomotic leaks is not known [11].…”

The management of colonic trauma in the damage control era

“…[18][19][20][21][22][23][24] Those with hypovolaemic shock, metabolic acidosis, systemic hypothermia and complex intra-abdominal injuries should be subjected to an abbreviated laparotomy. Both PR and formal PD are inappropriate in this setting, and it is highly likely that a significant proportion of the PD patients in this series may have been better served by a DC approach.…”

“…Figure 2 depicts a suggested algorithm for the management of colonic trauma based on our data and on contemporary reviews. 22,23 If there are no indications for DC surgery and the colonic injuries are non-destructive, then PR is uncontroversial. If there are indications for DC surgery, this must be offered and PD should be avoided.…”

“…Our data are insufficient to draw any definitive conclusions but our experience suggests that delayed PR is an acceptable option if the patient's physiology has normalised completely. [18][19][20][21][22][23][24] Nevertheless, if there is persistent lactic acidosis and haemodynamic instability, then formal diversion remains the safest option. Continued collection of routine data as part of a trauma registry is needed to attempt to answer this question.…”

“…The principle of DC is to avoid all definitive surgery in the unstable patient at the initial operation, and to control bleeding and soiling in an abbreviated procedure. [18][19][20][21][22][23][24] The controversies in colonic trauma revolve currently around management of destructive colonic injuries, initial selection of cases for DC and (once a DC approach has been chosen) how to manage colonic injuries that have been temporised during the initial procedure. The purpose of this study was to audit our current management and outcomes of colonic trauma, to review our experience of colonic trauma in patients who underwent DC surgery and to produce a clinical algorithm for assisting with the management of these injuries.…”