Diversion in the management of colorectal injuries remained the standard of care during the period from 1950 to 1980, however. In the last 10 years, primary repair has assumed an increasing role.
The records of 33 cases treated for colorectal injuries at the department of Surgery, Soon Chun Hyang University Hospital during 10 year period from January 1982 to january 1992 were reviewed.
1) Of the 33 cases analyzed, 25 cases were male and the ratio of male to female was 3 :1, and the age incidence was most prevalent in 3rd and 4th decade.
2) Mechanisms of colon injury included traffic accident(16 cases, 48.5%), stab wound(10 cases, 30.3%) and others.
3) Transverse colon was the segment most often injured, occurring in 19 cases(46.4%), followed by the sigmoid colon in 7 cases(17.1%) and the ascending colon in 5 cases(12.2%). Among the 33 cases, 8 cases had injuries to more than one location.
4) The small bowel, among the associated intraabdominal injuries, was the most frequent site, occurring in 12 cases(48.0%), and an additional 5 cases(20.0%) had renal injuries. Injuries in pancreas, bladder and major vessel occurred in 2
cases(8.0%),
one another.
5) Four difference methods were used to treat the colon injuries. Primary repairs were performed in 24 cases(72.7%), including simple closure in 15 cases(45.5%). resection with anastomosis in 9 cases(27.2%). Colostomies were performed in 6
cases(18.2%). Exteriorized repairs were performed in 3 cases(9.1%).
6) Complication related to the suture line failure occurred in 2 cases(8.3%) of patients treated with primary repair.
7) The overall morbidity rate was 30.3% and the most common postoperative complication was wound infection(5 cases, 38.5%), pulmonary complication(3 cases, 23.2%), fecal fistula(2 cases, 15.3%), sepsis(1 cases, 7.7%), intraabdominal abscess(1
cases,
7.7%), intestinal obstruction(1 cases, 7.7%) in that order.
8) Various risk factors for the development of complication following colon injury had been identified. We, however, had defined that fecal contamination and concomitant abdominal injuries were the major contraindication to primary repair, and
delay of
surgery, transfusion requirements, age, bowel edema due to longstanding shock state and extra-abdominal injuries were thought to be relative contraindication to primary repair.
9) The advantages of primary repair were due to decreased morbidity from a second operation, significant fiscal gain, less psycholoigcal effect and short hospital stay.
10) We concluded that primary repair should be the mainstay for the treatment of most civilian colorectal injuries.
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