Injuries to the colon represent a challenging and controversial facet of trauma surgery. Historically, diversion was considered to be the standard of care for all colon injuries. Recently, however, significant data have emerged that has demonstrated the safety of performing primary anastomoses after colonic injuries. This chapter reviews indications for performing a colostomy in injured patients. There are also unique anatomic and physiologic issues that surgeons must consider when performing a colostomy for trauma. Injured patients are more likely to require an “open abdomen” and are more likely to have devascularization secondary to blast effects or vessel trauma. These situations require special attention to diversion of fecal contents away from the open wound as well as accurate appreciation of the extent of devascularization. This chapter reviews the techniques for performing a colostomy that are germane to injured patients.
KeywordsPelvic Fracture Primary Repair Gunshot Wound Open Abdomen Colonic Injury