G V Oosthuizen1,2, S R Čačala3,4, V Y Kong5, D Couch6, J Buitendag7, S Variawa8, N Allen9, D L Clarke3,10. 1. Department of Surgery, University of KwaZulu-Natal, Durban, South Africa. George.oost@gmail.com. 2. Department of Surgery, Ngwelezana Hospital, Empangeni, South Africa. George.oost@gmail.com. 3. Department of Surgery, University of KwaZulu-Natal, Durban, South Africa. 4. Department of Surgery, Ngwelezana Hospital, Empangeni, South Africa. 5. Department of Surgery, University of the Witwatersrand, 29 Princess of Wales Terrace, Parktown, Johannesburg, 2193, South Africa. 6. Department of Surgery, Queens Medical Centre, Nottingham, UK. 7. Department of Surgery, University of Stellenbosch, Cape Town, South Africa. 8. Department of Surgery, Khayelitsha District Hospital, Cape Town, South Africa. 9. Department of Surgery, Auckland City Hospital, Auckland, New Zealand. 10. Department of Surgery, Grey's Hospital, Pietermaritzburg, South Africa.
Abstract
BACKGROUND: There is limited evidence to suggest that the more distal a penetrating colonic injury, the poorer its expected outcome, prompting consideration of diversion rather than anastomosis when faced with left colonic injury. The clinical outcomes of penetrating colonic trauma in relation to their anatomical location within the colon were reviewed. METHODS: A review was performed over eight years (2012-2020) of all patients over 18 years who had sustained penetrating colon injury and presented to our trauma centre in South Africa. Direct comparison was made between right colon vs left colon injuries. RESULTS: A total of 450 patients were included; right colon: 260, left colon: 190. Gunshots predominated in the right colon, and the PATI was higher in this group. There were minimal differences in admission physiology and blood gas parameters between groups, but higher damage control surgery and ICU admission rates for the right colon group. There were similar rates of primary repair, anastomosis, and stoma between groups. Leak rates were no different between the two groups, and although overall complication rates were higher for the right colon, there was no difference with regard to gastro-intestinal and other complications, nor for mortality. While regression analysis did identify PATI to be a risk factor for overall complications and mortality, it failed to do so for anastomotic leak. CONCLUSION: Our study did not demonstrate any difference in anastomotic leak rates or mortality between right vs left colonic injury. We recommend that all colonic injuries should be treated on their own merit, balanced against the patient's condition, regardless of anatomical location within the colon.
BACKGROUND: There is limited evidence to suggest that the more distal a penetrating colonic injury, the poorer its expected outcome, prompting consideration of diversion rather than anastomosis when faced with left colonic injury. The clinical outcomes of penetrating colonic trauma in relation to their anatomical location within the colon were reviewed. METHODS: A review was performed over eight years (2012-2020) of all patients over 18 years who had sustained penetrating colon injury and presented to our trauma centre in South Africa. Direct comparison was made between right colon vs left colon injuries. RESULTS: A total of 450 patients were included; right colon: 260, left colon: 190. Gunshots predominated in the right colon, and the PATI was higher in this group. There were minimal differences in admission physiology and blood gas parameters between groups, but higher damage control surgery and ICU admission rates for the right colon group. There were similar rates of primary repair, anastomosis, and stoma between groups. Leak rates were no different between the two groups, and although overall complication rates were higher for the right colon, there was no difference with regard to gastro-intestinal and other complications, nor for mortality. While regression analysis did identify PATI to be a risk factor for overall complications and mortality, it failed to do so for anastomotic leak. CONCLUSION: Our study did not demonstrate any difference in anastomotic leak rates or mortality between right vs left colonic injury. We recommend that all colonic injuries should be treated on their own merit, balanced against the patient's condition, regardless of anatomical location within the colon.
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