Colon and rectal injuries: Contemporary management
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Colon and Rectal Injuries: Contemporary Management Review Article N. Kontopodis, P. Taflampas, K. Spiridakis, T. Papadakis, T. Kokkinakis, L. Rokadakis Received 29/04/2011 Accepted 19/06/2011
Abstract Colon and rectal injuries pose major challenges for the operating surgeon. Modern management takes into account the time elapsed from injury, the site and extent of the injury and the overall status of the patient. Colostomy in every case has evolved to become a more selective approach. Primary anastomosis is now considered feasible in most cases. The long-standing different approach to right and left colon injuries is debated. Intraperitoneal rectal injuries can be managed similar to left colon injuries by primary repair, whereas the mainstay of management of extraperitoneal injuries remains proximal colostomy. The extent of injury, associated abdominal injuries, presence of shock, number of blood transfusions and the time from injury to operation determine the decision-making process and the prognosis for these patients.
Key words
Colon injuries, Rectal injuries, Primary anastomosis, Faecal diversion
Introduction During the first World War, the overall mortality rate from colonic injury was around 60% [1,2]. Colostomy was the treatment of choice during World War II with a reported decrease in mortality from 60% to 30%. Like colonic injuries, faecal diversion for penetrating rectal injuries was popularized during World War II. Mortality from rectal injuries decreased from 90% before World War I, when non-operative management was customary, to 67% during World War I when primary suture was employed, and to 30% during World War II when faecal diversion and presacral drainage was established [1,2]. Colon and rectal injuries occur in both penetrating and blunt abdominal trauma. Colon injury is rare in blunt abdominal trauma and accounts for
N. Kontopodis, P. Taflampas (Corresponding author), K. Spiridakis, T. Papadakis, T. Kokkinakis, L. Rokadakis - Venizeleion General Hospital, Herakleion, Crete, Greece e-mail: [email protected]
only 5% of all cases [3]. On the other hand, colon and rectal injuries following penetrating abdominal trauma are far more common and account for 17% of abdominal injuries [3]. Colon injuries are more common in urban centres and firearms are by far the most common cause of injury. In anterior stab wounds, the colon is the 3rd most commonly injured organ whereas in posterior stab wounds it is the most frequently injured organ. The left colon is more frequently injured in stab wounds, possibly owing to the predominance of right-handed assailants. Rectal injuries are rare and usually the result of penetrating trauma. In most series, shotgun wounds account for 80% of rectal injuries and stab wounds 5% [1]. Rectal injuries are common among patients with associated pelvic injuries. The treatment of these injuries is controversial. The aim of this review is to present the current management of colon and rectal injuries.
Colon Injuries Diagnosis The diagnosis of colon injuries may be difficult e
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