Colon trauma: further support for primary repair.

During a 5 year period, 137 patients who sustained intraperitoneal colon injuries were retrospectively analyzed. One hundred fourteen were considered for evaluation. The method of colon wound management and infectious complications thought to be secondary to the colon wound were reviewed. These patients were admitted to the trauma service and underwent exploratory laparotomy for their injuries. The penetrating abdominal trauma index, as well as other risk factors, were evaluated for their efficacy in predicting potential complications associated with the colon wound. Sixty-four percent of patients were managed by primary closure, 27 percent by end colostomy or end ileostomy, and 9 percent by exteriorization of the injury. The complication rates for these categories were 18, 42, and 40 percent, respectively. There were no significant differences in complications in terms of location and mode of injury. This review confirms that the presence of shock, transfusion (4 or more units), significant contamination, and associated injuries (evaluated by the penetrating abdominal trauma index) contribute to the development of complications. There were no disruptions of the suture line in the primary closure group. We believe that infections and septic complications are secondary to the original injury to the colon and not related to the method of repair. Primary repair of all colon wounds not requiring resection may be feasible. Prospective evaluation of that approach is indicated.