Traumatic lesions of the colon and upper rectum: surgical repair impact

Abstract

Objectives: To evaluate the management of traumatic lesions of the colon and upper rectum at Hospital Jesus Maria Casal ,
Acarigua, Estado Portuguesa. Patients and methods: Retrospective review. Patients were stratified without exclusion criterias: a) Primary Repair (PR), patients subjected to closed primary or resection and anastomosis of the colon or rectum. b) Colostomy. The morbimortality related was studied as well as the risk factors for adverse results. The results were analyzed using the Fischer test and Chi squared. Results: 104 patients were included in the study. 91 (87.5%) patients in the PR, Penetrating Abdominal Trauma Index (PATI) = 21,48. Thirteen patients in the colostomy group (12,5%), PATI = 22,30. Gunshot wounds (GSW) accounted for the majority of traumatic colon injury in both groups (75, 82% RP and 92,30% colostomy). In the RP for GSW the PATI = 24,05 and in 36 of these patients it was >25, where 14 of these showed colon-related morbidity (38,88%). In the colostomy for GSW, patients with PATI greater, equal or lower than 25 showed similar behavior with respect to morbidity, which suggests that colostomy can be an independent risk factor for the development of infections complications. In the RP, 23 patients (25,27%) were subjected to resection-anastomosis with an increase in the morbidity. In the RP there was 4,39% failure of the suture line and 9,89% of intraabdominal abscesses vs 15,38 % in the colostomy group. The presence of shock associated to blood transfusions in the RP seems to be associated to complications in the suture line of colon. There was 2,19% mortality colon-related to RP, .with no deaths in the colostomy group. This result was not statistically significant. Conclusions: These lesions, particularly GSW, with PATI> 25 and hemodynamic instability, that require blood transfusions, should be considered for a colostomy.