Primary Repair versus Colonic Diversion in Large Bowel Trauma

Abstract

ABSTRACT

Background: Most colonic wounds were managed by exteriorization of injury or proximal colostomy because of the fear of breakdown. In the past 20 years, primary repair has been increasingly practiced. Advantages of primary repair are the avoidance of colostomy care and its complications and the subsequent hospitalization for closure. Potential drawbacks of primary repair are the morbidity and mortality associated with failure of repair.

Objectives: To compare the results between colostomy and primary colonic repair for large bowel trauma.

Methods: this is a prospective study of 57 patients admitted to the surgical ward of Baghdad teaching hospital with large bowel trauma between October 2009 and October 2011. They were reviewed according to age, sex, mechanism of injury, time from injury to operation, degree of peritoneal contamination, associated injuries, blood pressure, blood loss, number of blood units received and grade of colorectal injury. According to these criteria, the operative management was divided into either primary repair or colostomy group

Result: Most patients were males (68.4%), young age group was more frequently involved, 47.3% of patients were in their third decade of life. Penetrating injury was the cause in majority of cases (90.2%), and most of them were due to bullet or shrapnel injuries (87.6 %). Grades II and III were more common (forming 68.3 % of injuries).  Mortality rate was (3.4%) of cases and the morbidity was (20.7%). Primary repair was used in (42.1%) while colostomy in (57.8 %).

Conclusion: Primary repair of large bowel trauma is safe with low mortality and morbidity in selected cases and in the absence of risk factors.