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Colon and Rectal Trauma

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Complexities in Colorectal Surgery

Abstract

The treatment of traumatic injuries to the colon and rectum is often driven by past dogma, despite the presence of evidence suggesting alternative methods of care that are associated with similar or improved outcomes. Whether from the battlefield, colonoscopy or foreign bodies, colorectal injuries remain a challenging clinical entity associated with significant morbidity and potential mortality. Familiarity with the different methods to approach and manage these injuries, including “damage control” tactics when necessary, will allow surgeons to minimize unnecessary complications and mortality.

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References

  1. Demetriades D, Murray JA, Chan L, Ordonez C, Bowley D, Nagy KK, et al. Penetrating colon injuries requiring resection: diversion or primary anastomosis? An AAST prospective multicenter study. J Trauma. 2001;50(5):765–75 [Multicenter Study].

    Article  CAS  PubMed  Google Scholar 

  2. Steele SR, Wolcott KE, Mullenix PS, Martin MJ, Sebesta JA, Azarow KS, et al. Colon and rectal injuries during Operation Iraqi Freedom: are there any changing trends in management or outcome? Dis Colon Rectum. 2007;50(6):870–7.

    Article  PubMed  Google Scholar 

  3. Cho SD, Kiraly LN, Flaherty SF, Herzig DO, Lu KC, Schreiber MA. Management of colonic injuries in the combat theater. Dis Colon Rectum. 2010;53(5):728–34.

    Article  PubMed  Google Scholar 

  4. Perry WB, Brooks JP, Muskat PC. The history of military colorectal trauma management. Semin Colon Rectal Surg. 2004;15(2):70–9.

    Article  Google Scholar 

  5. Cirillo VJ. “More fatal than powder and shot”: dysentery in the U.S. Army during the Mexican War, 1846–48. Perspect Biol Med. 2009;52(3):400–13.

    Article  PubMed  Google Scholar 

  6. Cirillo VJ. Two faces of death: fatalities from disease and combat in America’s principal wars, 1775 to present. Perspect Biol Med. 2008;51(1):121–33.

    Article  PubMed  Google Scholar 

  7. MacCormac W. Some points of interest in connection with the surgery of war. Br Med J. 1895;ii:278–84.

    Article  Google Scholar 

  8. Bennett JD. Abdominal surgery in war – the early story. J R Soc Med. 1991;84(9):554–7.

    CAS  PubMed Central  PubMed  Google Scholar 

  9. Derby AC. Wounds of the abdomen. Part 1: in war. Can J Surg. 1988;31(4):213–8.

    CAS  PubMed  Google Scholar 

  10. Bowlby A, Wallace C. The development of British surgery at the front. Br Med J. 1917;1(2944):705–21.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  11. Rignault DP. Abdominal trauma in war. World J Surg. 1992;16(5):940–6.

    Article  CAS  PubMed  Google Scholar 

  12. Ogilvie WH. Abdominal wounds in the Western Desert. Bull U S Army Med Dep. 1946;6(4):435–45.

    CAS  PubMed  Google Scholar 

  13. Edwards DP. The history of colonic surgery in war. J R Army Med Corps. 1999;145(2):107–8.

    Article  CAS  PubMed  Google Scholar 

  14. Office of the Surgeon General: Circular Letter No. 178. 1943.

    Google Scholar 

  15. Welch CE. War wounds of the abdomen. N Engl J Med. 1947;237(6):187–94.

    Article  CAS  PubMed  Google Scholar 

  16. Middleton CJ, Wayne MA. Exteriorization of repaired missile wounds of the colon. J Trauma. 1973;13(5):460–2.

    Article  CAS  PubMed  Google Scholar 

  17. Vertrees A, Wakefield M, Pickett C, Greer L, Wilson A, Gillern S, et al. Outcomes of primary repair and primary anastomosis in war-related colon injuries. J Trauma. 2009;66(5):1286–91; discussion 91–3 [Comparative Study].

    Article  PubMed  Google Scholar 

  18. Glasgow SC, Steele SR, Duncan JE, Rasmussen TE. Epidemiology of modern battlefield colorectal trauma: a review of 977 coalition casualties. J Trauma. 2012;73:S503–8.

    Article  Google Scholar 

  19. Sambasivan CN, Underwood SJ, Cho SD, Kiraly LN, Hamilton GJ, Kofoed JT, et al. Comparison of abdominal damage control surgery in combat versus civilian trauma. J Trauma. 2010;69 Suppl 1:S168–74.

    Article  PubMed  Google Scholar 

  20. Blackbourne LH. Combat damage control surgery. Crit Care Med. 2008;36(7 Suppl):S304–10.

    Article  PubMed  Google Scholar 

  21. Blackbourne LH. Defining combat damage control surgery. US Army Med Dep J. 2008:67–72.

    Google Scholar 

  22. Eshraghi N, Mullins RJ, Mayberry JC, Brand DM, Crass RA, Trunkey DD. Surveyed opinion of American trauma surgeons in management of colon injuries. J Trauma. 1998;44(1):93–7.

    Article  CAS  PubMed  Google Scholar 

  23. Welling DR, Hutton JE, Minken SL, Place RJ, Burris DG. Diversion defended – military colon trauma. J Trauma. 2008;64(4):1119–22.

    Article  PubMed  Google Scholar 

  24. Leppaniemi AK, Haapiainen RK. Selective nonoperative management of abdominal stab wounds: prospective, randomized study. World J Surg. 1996;20(8):1101–5; discussion 5–6.

    Article  CAS  PubMed  Google Scholar 

  25. Salim A, Sangthong B, Martin M, Brown C, Plurad D, Inaba K, et al. Use of computed tomography in anterior abdominal stab wounds: results of a prospective study. Arch Surg. 2006;141(8):745–50; discussion 50–2.

    Article  PubMed  Google Scholar 

  26. Martin MJ, Beekley A, editors. Front line surgery: a practical approach. 1st ed. New York: Springer; 2011.

    Google Scholar 

  27. Inaba K. Prospective evaluation of ambient operating room temperature on the core temperature of injured patients undergoing emergent surgery. J Trauma. 2012;73(6):1478–83.

    Google Scholar 

  28. Nichols RL, Broido P, Condon RE, Gorbach SL, Nyhus LM. Effect of preoperative neomycin-erythromycin intestinal preparation on the incidence of infectious complications following colon surgery. Ann Surg. 1973;178(4):453–62.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  29. Slim K, Vicaut E, Launay-Savary MV, Contant C, Chipponi J. Updated systematic review and meta-analysis of randomized clinical trials on the role of mechanical bowel preparation before colorectal surgery. Ann Surg. 2009;249(2):203–9.

    Article  PubMed  Google Scholar 

  30. Fa-Si-Oen P, Roumen R, Buitenweg J, van de Velde C, van Geldere D, Putter H, et al. Mechanical bowel preparation or not? Outcome of a multicenter, randomized trial in elective open colon surgery. Dis Colon Rectum. 2005;48(8):1509–16.

    Article  PubMed  Google Scholar 

  31. Goldberg SR, Anand RJ, Como JJ, Dechert T, Dente C, Luchette FA, et al. Prophylactic antibiotic use in penetrating abdominal trauma: an Eastern Association for the Surgery of Trauma practice management guideline. J Trauma Acute Care Surg. 2012;73(5 Suppl 4):S321–5.

    Article  CAS  PubMed  Google Scholar 

  32. Danne PD. Intra-operative colonic lavage: safe single-stage, left colorectal resections. Aust N Z J Surg. 1991;61(1):59–65.

    Article  CAS  PubMed  Google Scholar 

  33. Lindsey D. The idolatry of velocity, or lies, damn lies, and ballistics. J Trauma. 1980;20(12):1068–9.

    Article  CAS  PubMed  Google Scholar 

  34. Fallon Jr WF. The present role of colostomy in the management of trauma. Dis Colon Rectum. 1992;35(11):1094–102.

    Article  PubMed  Google Scholar 

  35. Oberkofler CE, Rickenbacher A, Raptis DA, Lehmann K, Villiger P, Buchli C, et al. A multicenter randomized clinical trial of primary anastomosis or Hartmann’s procedure for perforated left colonic diverticulitis with purulent or fecal peritonitis. Ann Surg. 2012;256(5):819–26; discussion 26–7.

    Article  PubMed  Google Scholar 

  36. Velmahos GC, Degiannis E, Wells M, Souter I, Saadia R. Early closure of colostomies in trauma patients – a prospective randomized trial. Surgery. 1995;118(5):815–20.

    Article  CAS  PubMed  Google Scholar 

  37. Morris DM, Rayburn D. Loop colostomies are totally diverting in adults. Am J Surg. 1991;161(6):668–71.

    Article  CAS  PubMed  Google Scholar 

  38. Klink CD, Lioupis K, Binnebosel M, Kaemmer D, Kozubek I, Grommes J, et al. Diversion stoma after colorectal surgery: loop colostomy or ileostomy? Int J Colorectal Dis. 2011;26(4):431–6.

    Article  PubMed  Google Scholar 

  39. Stone HH, Fabian TC. Management of perforating colon trauma: randomization between primary closure and exteriorization. Ann Surg. 1979;190(4):430–6.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  40. Chappuis CW, Frey DJ, Dietzen CD, Panetta TP, Buechter KJ, Cohn Jr I. Management of penetrating colon injuries. A prospective randomized trial. Ann Surg. 1991;213(5):492–7; discussion 7–8.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  41. Sasaki LS, Allaben RD, Golwala R, Mittal VK. Primary repair of colon injuries: a prospective randomized study. J Trauma. 1995;39(5):895–901.

    Article  CAS  PubMed  Google Scholar 

  42. Kamwendo NY, Modiba MC, Matlala NS, Becker PJ. Randomized clinical trial to determine if delay from time of penetrating colonic injury precludes primary repair. Br J Surg. 2002;89(8):993–8.

    Article  CAS  PubMed  Google Scholar 

  43. Musa O, Ghildiyal JP, C Pandey M. 6 year prospective clinical trial of primary repair versus diversion colostomy in colonic injury cases. Indian J Surg. 2010;72(4):308–11.

    Article  PubMed Central  PubMed  Google Scholar 

  44. Cornwell 3rd EE, Velmahos GC, Berne TV, Murray JA, Chahwan S, Asensio J, et al. The fate of colonic suture lines in high-risk trauma patients: a prospective analysis. J Am Coll Surg. 1998;187(1):58–63.

    Article  PubMed  Google Scholar 

  45. Edwards DP. Prospective audit of multiple penetrating injuries to the colon: further support for primary closure. J R Coll Surg Edinb. 1997;42(1):62.

    CAS  PubMed  Google Scholar 

  46. Thomson SR, Baker A, Baker LW. Prospective audit of multiple penetrating injuries to the colon: further support for primary closure. J R Coll Surg Edinb. 1996;41(1):20–4.

    CAS  PubMed  Google Scholar 

  47. Ivatury RR, Gaudino J, Nallathambi MN, Simon RJ, Kazigo ZJ, Stahl WM. Definitive treatment of colon injuries: a prospective study. Am Surg. 1993;59(1):43–9.

    CAS  PubMed  Google Scholar 

  48. George Jr SM, Fabian TC, Voeller GR, Kudsk KA, Mangiante EC, Britt LG. Primary repair of colon wounds. A prospective trial in nonselected patients. Ann Surg. 1989;209(6):728–33; 733–4.

    Article  PubMed Central  PubMed  Google Scholar 

  49. Almqvist PM, Bohe M, Montgomery A. Laparoscopic creation of loop ileostomy and sigmoid colostomy. Eur J Surg. 1995;161(12):907–9.

    CAS  PubMed  Google Scholar 

  50. Lyerly HK, Mault JR. Laparoscopic ileostomy and colostomy. Ann Surg. 1994;219(3):317–22.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  51. van der Sluis FF, Schouten N, de Graaf PW, Karsten TM, Stassen LP. Temporary end ileostomy with subcutaneously buried efferent limb: results and potential advantages. Dig Surg. 2010;27(5):403–8.

    Article  PubMed  Google Scholar 

  52. Prasad ML, Pearl RK, Orsay CP, Abcarian H. End-loop ileocolostomy for massive trauma to the right side of the colon. Arch Surg. 1984;119(8):975–6.

    Article  CAS  PubMed  Google Scholar 

  53. Gonzalez RP, Falimirski ME, Holevar MR. The role of presacral drainage in the management of penetrating rectal injuries. J Trauma. 1998;45(4):656–61.

    Article  CAS  PubMed  Google Scholar 

  54. Burlew CC, Moore EE, Cuschieri J, Jurkovich GJ, Codner P, Crowell K, et al. Sew it up! A Western Trauma Association multi-institutional study of enteric injury management in the postinjury open abdomen. J Trauma. 2011;70(2):273–7 [Multicenter Study].

    Article  PubMed  Google Scholar 

  55. Higa G, Friese R, O’Keeffe T, Wynne J, Bowlby P, Ziemba M, et al. Damage control laparotomy: a vital tool once overused. J Trauma. 2010;69(1):53–9.

    Article  PubMed  Google Scholar 

  56. Martin MJ, Hatch Q, Cotton B, Holcomb J. The use of temporary abdominal closure in low-risk trauma patients: helpful or harmful? J Trauma Acute Care Surg. 2012;72(3):601–6; discussion 6–8.

    Article  PubMed  Google Scholar 

  57. Velmahos GC, Vassiliu P, Demetriades D, Chan LS, Murray J, Salim A, et al. Wound management after colon injury: open or closed? A prospective randomized trial. Am Surg. 2002;68(9):795–801.

    PubMed  Google Scholar 

  58. Crispin A, Birkner B, Munte A, Nusko G, Mansmann U. Process quality and incidence of acute complications in a series of more than 230,000 outpatient colonoscopies. Endoscopy. 2009;41(12):1018–25.

    Article  CAS  PubMed  Google Scholar 

  59. Damore 2nd LJ, Rantis PC, Vernava 3rd AM, Longo WE. Colonoscopic perforations. Etiology, diagnosis, and management. Dis Colon Rectum. 1996;39(11):1308–14.

    Article  PubMed  Google Scholar 

  60. Quallick MR, Brown WR. Rectal perforation during colonoscopic retroflexion: a large, prospective experience in an academic center. Gastrointest Endosc. 2009;69(4):960–3.

    Article  PubMed  Google Scholar 

  61. Gores PF, Simso LA. Splenic injury during colonoscopy. Arch Surg. 1989;124(11):1342.

    Article  CAS  PubMed  Google Scholar 

  62. Arora G, Mannalithara A, Singh G, Gerson LB, Triadafilopoulos G. Risk of perforation from a colonoscopy in adults: a large population-based study. Gastrointest Endosc. 2009;69(3 Pt 2):654–64.

    Article  PubMed  Google Scholar 

  63. Rabeneck L, Saskin R, Paszat LF. Onset and clinical course of bleeding and perforation after outpatient colonoscopy: a population-based study. Gastrointest Endosc. 2011;73(3):520–3.

    Article  PubMed  Google Scholar 

  64. Mai CM, Wen CC, Wen SH, Hsu KF, Wu CC, Jao SW, et al. Iatrogenic colonic perforation by colonoscopy: a fatal complication for patients with a high anesthetic risk. Int J Colorectal Dis. 2010;25(4):449–54.

    Article  PubMed  Google Scholar 

  65. Panteris V, Haringsma J, Kuipers EJ. Colonoscopy perforation rate, mechanisms and outcome: from diagnostic to therapeutic colonoscopy. Endoscopy. 2009;41(11):941–51.

    Article  CAS  PubMed  Google Scholar 

  66. La Torre M, Velluti F, Giuliani G, Di Giulio E, Ziparo V, La Torre F. Promptness of diagnosis is the main prognostic factor after colonoscopic perforation. Colorectal Dis. 2012;14(1):e23–6.

    Article  PubMed  Google Scholar 

  67. Rumstadt B, Schilling D. Optimizing time management after perforation by colonoscopy results in better outcome for the patients. Hepatogastroenterology. 2008;55(85):1308–10.

    PubMed  Google Scholar 

  68. Pieracci FM, Barie PS. Management of severe sepsis of abdominal origin. Scand J Surg. 2007;96(3):184–96.

    CAS  PubMed  Google Scholar 

  69. Berger D, Buttenschoen K. Management of abdominal sepsis. Langenbecks Arch Surg. 1998;383(1):35–43.

    Article  CAS  PubMed  Google Scholar 

  70. Singh JP, Steward MJ, Booth TC, Mukhtar H, Murray D. Evolution of imaging for abdominal perforation. Ann R Coll Surg Engl. 2010;92(3):182–8.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  71. Thill V, Simoens C, Mendes da Costa P. Management of latrogenic perforation after gastrointestinal endoscopy. Hepatogastro-enterology. 2010;57(104):1465–8.

    Google Scholar 

  72. Rumstadt B, Schilling D, Sturm J. The role of laparoscopy in the treatment of complications after colonoscopy. Surg Laparosc Endosc Percutan Tech. 2008;18(6):561–4.

    Article  PubMed  Google Scholar 

  73. Rogers AC, Collins D, O’Sullivan GC, Winter DC. Laparoscopic lavage for perforated diverticulitis: a population analysis. Dis Colon Rectum. 2012;55(9):932–8.

    Article  PubMed  Google Scholar 

  74. Liang S, Russek K, Franklin Jr ME. Damage control strategy for the management of perforated diverticulitis with generalized peritonitis: laparoscopic lavage and drainage vs. laparoscopic Hartmann’s procedure. Surg Endosc. 2012;26(10):2835–42.

    Article  PubMed  Google Scholar 

  75. Toorenvliet BR, Swank H, Schoones JW, Hamming JF, Bemelman WA. Laparoscopic peritoneal lavage for perforated colonic diverticulitis: a systematic review. Colorectal Dis. 2010;12(9):862–7.

    Article  CAS  PubMed  Google Scholar 

  76. Mukherjee K, Pichert JW, Cornett MB, Yan G, Hickson GW, Diaz Jr JJ. All trauma surgeons are not created equal: asymmetric distribution of malpractice claims risk. J Trauma. 2010;69(3):549–54; discussion 54–6.

    Article  PubMed  Google Scholar 

  77. Hickson GB, Jenkins AD. Identifying and addressing communication failures as a means of reducing unnecessary malpractice claims. N C Med J. 2007;68(5):362–4.

    PubMed  Google Scholar 

  78. Hickson GB, Federspiel CF, Pichert JW, Miller CS, Gauld-Jaeger J, Bost P. Patient complaints and malpractice risk. JAMA. 2002;287(22):2951–7.

    Article  PubMed  Google Scholar 

  79. Anderson KL, Dean AJ. Foreign bodies in the gastrointestinal tract and anorectal emergencies. Emerg Med Clin North Am. 2011;29(2):369–400, ix [Review].

    Article  PubMed  Google Scholar 

  80. Goldberg JE, Steele SR. Rectal foreign bodies. Surg Clin North Am. 2010;90(1):173–84, Table of Contents [Review].

    Article  PubMed  Google Scholar 

  81. Traub SJ, Hoffman RS, Nelson LS. Body packing – the internal concealment of illicit drugs. N Engl J Med. 2003;349(26):2519–26.

    Article  CAS  PubMed  Google Scholar 

  82. Lake JP, Essani R, Petrone P, Kaiser AM, Asensio J, Beart Jr RW. Management of retained colorectal foreign bodies: predictors of operative intervention. Dis Colon Rectum. 2004;47(10):1694–8.

    Article  PubMed  Google Scholar 

  83. Ooi BS, Ho YH, Eu KW, Nyam D, Leong A, Seow-Choen F. Management of anorectal foreign bodies: a cause of obscure anal pain. Aust N Z J Surg. 1998;68(12):852–5.

    Article  CAS  PubMed  Google Scholar 

  84. Song D, Chen CS, Zeng XD, Dai XW. Nonoperative management for large rectal foreign body removal. Colorectal Dis. 2011;13(6):e163–4 [Case Reports].

    Article  CAS  PubMed  Google Scholar 

  85. van der Wouden EJ, Westerveld BD. Extraction of a rectal foreign body using a custom-made giant snare. Endoscopy. 2010;42 Suppl 2:E122 [Case Reports].

    Article  PubMed  Google Scholar 

  86. Billi P, Bassi M, Ferrara F, Biscardi A, Villani S, Baldoni F, et al. Endoscopic removal of a large rectal foreign body using a large balloon dilator: report of a case and description of the technique. Endoscopy. 2010;42 Suppl 2:E238 [Case Reports].

    Article  CAS  PubMed  Google Scholar 

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Correspondence to Matthew J. Martin MD, FACS .

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Martin, M.J., Brown, C.V.R. (2014). Colon and Rectal Trauma. In: Steele, S.R., Maykel, J.A., Champagne, B.J., Orangio, G.R. (eds) Complexities in Colorectal Surgery. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-9022-7_34

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