The conundrum of traumatic colon injury.

Abstract

BACKGROUND: Surgical care in the case of traumatic injury to the colon has changed significantly. During World War II, diversion was dictum. Current trends favor primary repair. METHODS: A retrospective chart review of traumatic colon injuries at an urban level 1 trauma center was performed. Multiple data points were collected. Colon-related complications were examined in detail. RESULTS: Seventy-four charts fulfilled inclusion criteria. The majority of patients were treated with primary repair. The median Colon Injury Scale (CIS) grade was 2, and the average Penetrating Abdominal Trauma Index (PATI) score was 19. Patients repaired by diversion suffered more colon-related complications; however, the difference was not statistically significant. CONCLUSIONS: The emerging dictum for traumatic colon injuries is primary repair. Questions remain as to whether primary repair is the safest option for all colon injuries. The PATI score, CIS grade, and multiple other factors should be included in the decision making algorithm with an emphasis on primary repair.