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Primary repairvs.colostomy for the treatment of penetrating colon injuries

 

作者: Cal Ridgeway,   Scott Frame,   Janet Rice,   Gregory Timberlake,   Norman Mc Swain,   Morris Kerstein,  

 

期刊: Diseases of the Colon & Rectum  (OVID Available online 1989)
卷期: Volume 32, issue 12  

页码: 1046-1049

 

ISSN:0012-3706

 

年代: 1989

 

出版商: OVID

 

关键词: Colostomy;Sepsis;Trauma;Colonic injury;Length of stay;Primary closure

 

数据来源: OVID

 

摘要:

&NA;The charts of 81 consecutive patients with penetrating colonic trauma were reviewed. Sixty‐five patients were considered for evaluation. Penetrating abdominal trauma index, associated injuries, length of operative procedure, wounding agent, length of hospital stay, method of treatment, and septic complications were evaluated. Twenty‐eight patients were treated with colostomy at the site of injury: five with diverting colostomy proximal to repair, 30 with primary repair (either single or multiple injuries), and two with exteriorization and early drop back. Overall septic morbidity was 15 of 65 (23 percent) patients. No statistically significant difference was found in morbidity between colostomy, 9 of 33 (27 percent), and primary repair, 6 of 30 (20 percent). The two patients with exteriorized repairs had no morbidity. No deaths were reported among the 65 patients studied. Thirty‐two of the 33 (97 percent) colostomies were later closed with morbidity in 7 of 32 (22 percent). The mean length of stay for primary repair patients was 10.3±2.8 days and for colostomy patients 25.7±3.8 days, counting days for both initial and colostomy closure admissions (P<.05). Colostomy was not mandated by anatomic location or number of colonic injuries, circumference of colonic wall involved, presence of fecal contamination, or involvement of mesenteric blood supply. This study indicates that primary repair does not carry an increased risk of septic complications and saves the patient the significant risk and increased hospital stay of colostomy closure. Prospective studies addressing this area are indicated.

 

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