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. 1999 Jan;81(1):58–61.

Universal primary colonic repair in the firearm era.

D L Clarke 1, S R Thomson 1, D J Muckart 1, P A Neijenhuis 1
PMCID: PMC2503243  PMID: 10325689

Abstract

All patients with colonic trauma treated at King Edward VIII Hospital, Durban, from August 1993 to May 1994 underwent primary repair of the colonic wound. They were evaluated prospectively to assess the mode of injury and outcome variables. Colonic injuries were sustained by 102 patients. These were inflicted by gunshots (62), stabs (22), shotguns (14), and blunt trauma (4). The transverse colon was injured most frequently (53). All shotgun injuries were multiple. Average time from admission to theatre was similar for shocked and non-shocked patients. Eighty-seven patients had simple closure (18 deaths) and 15 required resection and anastomosis (eight deaths). Ten patients died in the first 48 h, and 16 died subsequently owing to multiple-organ systems dysfunction. The mortality rates were stabs 9% (2), gunshots 27% (17), shotguns 50% (7), and 0% for blunt trauma. Septic morbidity was seen in 16 but was not related to breakdown of the colonic repair. Implementation of strategies to reduce preoperative time delays and use damage control principles for the management of massive trauma should be evaluated as methods of reducing mortality.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Baker L. W., Thomson S. R., Chadwick S. J. Colon wound management and prograde colonic lavage in large bowel trauma. Br J Surg. 1990 Aug;77(8):872–876. doi: 10.1002/bjs.1800770809. [DOI] [PubMed] [Google Scholar]
  2. Burch J. M., Ortiz V. B., Richardson R. J., Martin R. R., Mattox K. L., Jordan G. L., Jr Abbreviated laparotomy and planned reoperation for critically injured patients. Ann Surg. 1992 May;215(5):476–484. doi: 10.1097/00000658-199205000-00010. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. Carty N. J., Corder A. P. Which surgeons avoid a stoma in treating left-sided colonic obstruction? Results of a postal questionnaire. Ann R Coll Surg Engl. 1992 Nov;74(6):391–394. [PMC free article] [PubMed] [Google Scholar]
  4. Chappuis C. W., Frey D. J., Dietzen C. D., Panetta T. P., Buechter K. J., Cohn I., Jr Management of penetrating colon injuries. A prospective randomized trial. Ann Surg. 1991 May;213(5):492–498. doi: 10.1097/00000658-199105000-00015. [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. George S. M., Jr, Fabian T. C., Voeller G. R., Kudsk K. A., Mangiante E. C., Britt L. G. Primary repair of colon wounds. A prospective trial in nonselected patients. Ann Surg. 1989 Jun;209(6):728–734. doi: 10.1097/00000658-198906000-00010. [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. Gonzalez R. P., Merlotti G. J., Holevar M. R. Colostomy in penetrating colon injury: is it necessary? J Trauma. 1996 Aug;41(2):271–275. doi: 10.1097/00005373-199608000-00012. [DOI] [PubMed] [Google Scholar]
  7. Hirshberg A., Mattox K. L. 'Damage control' in trauma surgery. Br J Surg. 1993 Dec;80(12):1501–1502. doi: 10.1002/bjs.1800801203. [DOI] [PubMed] [Google Scholar]
  8. Hirshberg A., Mattox K. L. Planned reoperation for severe trauma. Ann Surg. 1995 Jul;222(1):3–8. doi: 10.1097/00000658-199507000-00002. [DOI] [PMC free article] [PubMed] [Google Scholar]
  9. Irvin T. T., Goligher J. C. Aetiology of disruption of intestinal anastomoses. Br J Surg. 1973 Jun;60(6):461–464. doi: 10.1002/bjs.1800600612. [DOI] [PubMed] [Google Scholar]
  10. Ivatury R. R., Gaudino J., Nallathambi M. N., Simon R. J., Kazigo Z. J., Stahl W. M. Definitive treatment of colon injuries: a prospective study. Am Surg. 1993 Jan;59(1):43–49. [PubMed] [Google Scholar]
  11. Muckart D. J., Meumann C., Botha J. B. The changing pattern of penetrating torso trauma in KwaZulu/Natal--a clinical and pathological review. S Afr Med J. 1995 Nov;85(11):1172–1174. [PubMed] [Google Scholar]
  12. Sasaki L. S., Allaben R. D., Golwala R., Mittal V. K. Primary repair of colon injuries: a prospective randomized study. J Trauma. 1995 Nov;39(5):895–901. doi: 10.1097/00005373-199511000-00013. [DOI] [PubMed] [Google Scholar]
  13. Schultz S. C., Magnant C. M., Richman M. F., Holt R. W., Evans S. R. Identifying the low-risk patient with penetrating colonic injury for selective use of primary repair. Surg Gynecol Obstet. 1993 Sep;177(3):237–242. [PubMed] [Google Scholar]
  14. Stone H. H., Fabian T. C. Management of perforating colon trauma: randomization between primary closure and exteriorization. Ann Surg. 1979 Oct;190(4):430–436. doi: 10.1097/00000658-197910000-00002. [DOI] [PMC free article] [PubMed] [Google Scholar]
  15. Thomson S. R., Baker A., Baker L. W. Prospective audit of multiple penetrating injuries to the colon: further support for primary closure. J R Coll Surg Edinb. 1996 Feb;41(1):20–24. [PubMed] [Google Scholar]
  16. Udén P., Blomquist P., Jiborn H., Zederfeldt B. Influence of proximal colostomy on the healing of a left colon anastomosis: an experimental study in the rat. Br J Surg. 1988 Apr;75(4):325–329. doi: 10.1002/bjs.1800750411. [DOI] [PubMed] [Google Scholar]
  17. Velmahos G. C., Souter I., Degiannis E., Hatzitheophilou C. Primary repair for colonic gunshot wounds. Aust N Z J Surg. 1996 Jun;66(6):344–347. doi: 10.1111/j.1445-2197.1996.tb01207.x. [DOI] [PubMed] [Google Scholar]

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