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Current Surgery Reports

, 6:19 | Cite as

Management of Penetrating Injury to the Left Colon

  • Nathaniel McQuay
Trauma Surgery (J. Diaz, Section Editor)
Part of the following topical collections:
  1. Trauma Surgery

Abstract

Purpose of Review

Does management and outcomes of penetrating injuries to the left colon differ?

Recent Findings

Management pendulum has swung from non-operative management during the Civil War era, to mandatory exploration and fecal diversion by WWII. Continuing advancements in medical management, anesthesia, and surgical techniques have led to the transition from mandatory fecal diversion to primary repair. Civilian trauma experience further supported this paradigm shift with identification of risk factors better defining the role of primary repair. Patients with non-destructive injuries benefited from primary repair, while in those with destructive injuries, resection, and anastomosis is recommended. Injury location historically has been managed with the bias of left-sided colonic injuries mandating fecal diversion due to concerns for increased complications. Evolving literature contradicts such logic as colonic related outcomes appear similar.

Summary

The majority of penetrating colon injuries can be managed safely with primary repair despite anatomic injury location as outcomes are similar.

Keywords

Penetrating trauma Colon injury Damage control Anastomotic leak Primary repair Fecal diversion 

Notes

Compliance with Ethical Guidelines

Conflict of interest

Nathaniel McQuay declares that he has no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

References

Recently published papers of particular interest have been highlighted as: ∙ Of importance

  1. 1.
    Fraser J, Drummond H. A clinical and experimental study of three hundred perforating wounds of the abdomen. Br Med J. 1917;1:321–30.CrossRefGoogle Scholar
  2. 2.
    Wallace C. A study of 1200 cases of gunshot wounds of the abdomen. Br J Surg. 1916;4:679–743.CrossRefGoogle Scholar
  3. 3.
    Ogilvie WH. Abdominal wounds in the western desert. Bull US Army Med Dep. 1946;6:435–45.Google Scholar
  4. 4.
    Office of the Surgeon General of the United States. Circular letter 178, colon injuries. Washington, DC. 1943;173.Google Scholar
  5. 5.
    Woodhall JP, Ochsner A. The management of perforating injuries of the colon and rectum in civilian practice. Surgery. 1951;29:305–20.PubMedGoogle Scholar
  6. 6.
    ∙ Stone HH, Fabian TC. Management of perforating colon trauma: randomization between primary closure and exteriorization. Ann Surg. 1979;190:430–6. Important study providing data supporting primary repair for management of penetrating colon injuries. Google Scholar
  7. 7.
    ∙ Pasquale M, Fabian TC. Practice management guidelines for trauma from the Eastern Association for the Surgery of Trauma. J Trauma. 1998;44:941–56. Established guideline. CrossRefGoogle Scholar
  8. 8.
    Nelson R, Singer M. Primary repair for penetrating colon injuries. Cochrane Database Syst Rev. 2003:CD002247.Google Scholar
  9. 9.
    DuBose J. Colonic trauma: indications for diversion vs repair. J Gastrointest Surg. 2009;13:403–4.CrossRefGoogle Scholar
  10. 10.
    Adesanya AA, Ekanem EE. A ten year study of penetrating injuries of the colon. Dis Colon Rectum. 2004;47:169–77.CrossRefGoogle Scholar
  11. 11.
    Steele SR, Wolcott KE, Mullenix PS, Martin MJ, Sebesta JA, Azarow KS, Beekley AC. Colon and rectal injuries during operation iraqi freedom: are there any changing trends in management or outcome? Dis Colon Rectum. 2007;50:970–7.CrossRefGoogle Scholar
  12. 12.
    ∙ Thompson JS, More EE, Moore JB. Comparison of penetrating injuries of the right and left colon. Ann Surg. 1981;193:414–8. Important study providing high level data as to similar outcomes based upon anatomic location of penetrating colon injuries. CrossRefGoogle Scholar
  13. 13.
    Sharpe JP, Magnotti LJ, Weinberg JA, Zarzaur BL, Shahan CP, Parks NA, Fabian TC. Impact of location on outcome after penetrating colon injuries. J Trauma Acute Care Surg. 2012;73:1428–33.CrossRefGoogle Scholar
  14. 14.
    Stewart RM, Fabian TC, Croce MA, Pritchard FE, Minard D, Kudsk KA. Is resection with primary anastomosis following destructive colon wounds always safe? Am J Surg. 1994;168:316–9.CrossRefGoogle Scholar
  15. 15.
    Griffiths JD. Surgical Anatomy of the blood supply of the distal colon. Ann R Coll Surg Engl. 1956;19:241–56.PubMedPubMedCentralGoogle Scholar
  16. 16.
    Meyers MA. Griffith’s point: critical anastomosis at the splenic flexure. Significance in ischemia of the colon. Am J Roentgenol. 1976;126:77–94.CrossRefGoogle Scholar
  17. 17.
    Dente CJ, Feliciano DV, Rozycki GS, Wyrzykowski AD, Nicholas JM, Salomome JP, Ingram WL. Suture line failures in intra-abdominal colonic trauma: is there an effect of segmental variations in blood supply on outcome? J Trauma. 2005;59:359–68.CrossRefGoogle Scholar
  18. 18.
    Hatch Q, Causey M, et al. Outcomes after colon trauma in the 21st century: an analysis of the U.S. National Trauma Data Bank. Surgery. 2013;154:397–403.CrossRefGoogle Scholar
  19. 19.
    Miller PR, Chang MC, Hoth JJ, Holmes JH, Merideth JW. Colonic resection in the setting of damage control laparotomy: is delayed anastomosis safe? Am Surg. 2007;73:606–10.PubMedGoogle Scholar
  20. 20.
    Vertress A, Wakefield M, Pickett C, Greer L, Wilson A, Gillern S, Nelson J, Aydelotte J, Stojadinovic A, Shriver C. Outcomes of primary repair and primary anastomosis in war-related colon injuries. J Trauma. 2011;70:595–602.CrossRefGoogle Scholar
  21. 21.
    Kashuk JL, Cothren CC, Moore EE, Johnson JL, Biffl WL, Barnett CC. Primary repair of civilian colon injuries is safe in the damage control scenario. Surgery. 2009;146:663–70.CrossRefGoogle Scholar
  22. 22.
    Weinburg JA, Griffin RL, Vandromme MJ, Melton SM, George RL, Reiff DA, Kerby JD, Rue LW. Management of colon wounds in the setting of damage control laparotomy: a cautionary tale. J Trauma. 2009;67:929–35.CrossRefGoogle Scholar
  23. 23.
    Ordonez CA, Pino LF, Badiel M, Sanchez AL, Loaiza J, Ballestas L, Puyana JC. Safety of performing a delayed anastomosis during damage control laparotomy in patients with destructive colon injuries. J Trauma. 2011;71:1512–8.PubMedPubMedCentralGoogle Scholar
  24. 24.
    Ott MM, Norris PR, Diaz JJ, Collier BR, Jenkins JM, Gunter OL, Morris JA. Colon anastomosis after damage control laparotomy: recommendations from 174 trauma colectomies. J Trauma. 2011;70:596–602.CrossRefGoogle Scholar
  25. 25.
    Burlew CC, Moore EE, Cuschieri J, Jurkovich GJ, Codner P, Crowell K, Nirula R, Hann J, Rowell SE, Kato CM. Sew it up! A western trauma Association multi-institutional study of enteric injury management in the post-injury open abdomen. J Trauma. 2011;70:273–7.CrossRefGoogle Scholar
  26. 26.
    Georgoff P, Perales P, Laguna B, Holena D, Reilly P, Simms C. Colonic injuries and the damage control abdomen: does management strategy matter? J Surg Res. 2013;181:293–9.CrossRefGoogle Scholar
  27. 27.
    ∙ Sharpe JP, Magnotti LJ, Weinburg JA, Shahan CP, Cullinan DR, Marino KA, Fabian TC, Croce MA. Applicability of an established management algorithm for destructive colon injuries after abbreviated laparotomy: a 17 year experience. J Am Coll Surg. 2014;218:636–41. Excellent series regarding effect of algorithm based operative decision making in penetrating colon injuries. CrossRefGoogle Scholar
  28. 28.
    Anjaria DJ, Ullman TM, Lavery R, Livingston DH. Management of colonic injuries in the setting of damage-control laparotomy: one shot to get it right. J Trauma Acute Care Surg. 2014;76:594–600.CrossRefGoogle Scholar
  29. 29.
    Tatebe LC, Jennings A, Tatebe K, Handy A, Prajapati P, Smith M, Do T, Ogola G, Gandi RR, Duane TM, Luk S, Petrey LB. Traumatic colon injury in damage control laparotomy- A multicenter trial: is it safe to do a delayed anastomosis? J Trauma Acute Care Surg. 2017;82:742–9.CrossRefGoogle Scholar
  30. 30.
    ∙ Trust MD, Brown CV. Penetrating injuries to the colon and rectum. Curr Trauma Rep. 2015;1:113–8. Very good review with evidence based clinical management algorithm. Google Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Division of Acute Care Surgery, University Hospital Cleveland Medical CenterCase Western Reserve UniversityClevelandUSA

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