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Colon Injury

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Colonic resection in the setting of damage control laparotomy: is delayed anastomosis safe?
Miller PR, Chang MC, Hoth JJ, Holmes JH 4th, Meredith JW.
Am Surg. 2007 Jun;73(6):606-9; discussion 609-10.

Rationale for inclusion: This is the first reported study supporting delayed colonic anastomosis following damage control laparotomy.

Citations - 62 (as of July 2017)

Colon injury after blunt abdominal trauma: results of the EAST Multi-Institutional Hollow Viscus Injury Study.
Williams MD, Watts D, Fakhry S.
J Trauma. 2003 Nov;55(5):906-12.

Rationale for inclusion: Results from this EAST multi-center trial concluded that despite a lack of definitive diagnostic modalities to reliably diagnose colon injuries, most are identified promptly.  The presence of colonic injury is associated with increased morbidity and complication rate.  

Citations - 73 (as of July 2017)

Handsewn versus stapled anastomosis in penetrating colon injuries requiring resection: a multicenter study.
Demetriades D, Murray JA, Chan LS, Ordoñez C, Bowley D, Nagy KK, Cornwell EE 3rd, Velmahos GC, Muñoz N, Hatzitheofilou C, Schwab CW, Rodriguez A, Cornejo C, Davis KA, Namias N, Wisner DH, Ivatury RR, Moore EE, Acosta JA, Maull KI, Thomason MH, Spain DA.
J Trauma. 2002 Jan;52(1):117-21.

Rationale for inclusion: A multi-center prospective study, this trial concluded that the method of colonic anastomosis (hand-sewn vs. stapled) does not affect complication rates and should be surgeon choice.

Citations - 67 (as of July 2017)

Penetrating colon injuries requiring resection: diversion or primary anastomosis? An AAST prospective multicenter study.
Demetriades D, Murray JA, Chan L, Ordoñez C, Bowley D, Nagy KK, Cornwell EE 3rd, Velmahos GC, Muñoz N, Hatzitheofilou C, Schwab CW, Rodriguez A, Cornejo C, Davis KA, Namias N, Wisner DH, Ivatury RR, Moore EE, Acosta JA, Maull KI, Thomason MH, Spain DA; Committee on Multicenter Clinical Trials. American Association for the Surgery of Trauma.
J Trauma. 2001 May;50(5):765-75.

Rationale for inclusion: This AAST prospective multi-institutional study from 19 trauma centers identified severe fecal contamination, transfusion of >4units of blood, and single agent antibiotic prophylaxis are risk factors for abdominal complications after penetrating colon injury, but the surgical method of colon injury management is not, concluding that primary anastomosis should be considered.  

Citations - 252 (as of July 2017)

Perioperative antibiotic use in high-risk penetrating hollow viscus injury: a prospective randomized, double-blind, placebo-control trial of 24 hours versus 5 days.
Kirton OC, O'Neill PA, Kestner M, Tortella BJ.
J Trauma. 2000 Nov;49(5):822-32.

Rationale for inclusion: Using a placebo-controlled randomized trial, this study found that patients with penetrating abdominal trauma and hollow-viscus injury should be treated with only 24 hours of broad spectrum antibiotics, with equivalent infectious complications to those patients treated with a prolonged course of antibiotics.

Citations - 67 (as of July 2017)

Colostomy in penetrating colon injury: is it necessary?
Gonzalez RP, Merlotti GJ, Holevar MR.
J Trauma. 1996 Aug;41(2):271-5.

Rationale for inclusion: This study supports previous data recommending all penetrating colonic injuries be primarily repaired with higher complications in those patients requiring diversion.

Citations - 152 (as of July 2017)

Primary repair of colon injuries: a prospective randomized study.
Sasaki LS, Allaben RD, Golwala R, Mittal VK.
J Trauma. 1995 Nov;39(5):895-901.

Rationale for inclusion: A single center, prospective analysis of 71 patients with penetrating colon injuries, this study found that repair or resection and primary anastomosis should be considered in all patients given higher complication rates in those patients undergoing diversion.

Citations - 214 (as of July 2017)

Management of penetrating colon injuries. A prospective randomized trial.
Chappuis CW, Frey DJ, Dietzen CD, Panetta TP, Buechter KJ, Cohn I Jr.
Ann Surg. 1991 May;213(5):492-7; discussion 497-8.

Rationale for inclusion: A prospective analysis of 56 patients with penetrating colon injuries, this study found that repair or resection and primary anastomosis should be considered in all patients given equivalent complication rates.

Citations - 225 (as of July 2017)

Primary repair of colon wounds. A prospective trial in nonselected patients.
George SM Jr, Fabian TC, Voeller GR, Kudsk KA, Mangiante EC, Britt LG.
Ann Surg. 1989 Jun;209(6):728-33; 733-4.

Rationale for inclusion: Using 102 patients with penetrating colon injuries, this study concluded that the majority of these injuries can be managed with repair or resection and primary anastomosis.

Citations - 228 (as of July 2017)

Risk of infection after penetrating abdominal trauma.
Nichols RL, Smith JW, Klein DB, Trunkey DD, Cooper RH, Adinolfi MF, Mills J.
N Engl J Med. 1984 Oct 25;311(17):1065-70.

Rationale for inclusion: Published in NEJM, this study concluded equivalent infectious complication rates between single or dual agent antibiotic prophylactic therapy (cefoxitin vs clindamycin and gentamicin).  Presence of injury to the left colon requiring colostomy, increased age, increased organ injury, and transfusion were associated with increases in infection.

Citations - 347 (as of July 2017)

Management of perforating colon trauma: randomization between primary closure and exteriorization.
Stone HH, Fabian TC.
Ann Surg. 1979 Oct;190(4):430-6.

Rationale for inclusion: Performed in the 1970s, this prospective study found primary colon repair had superior outcomes as compared to colostomy in the absence of preoperative shock or >20% blood loss, with 2 or less abdominal organ injuries, and minimal intraabdominal contamination.

Citations - 356 (as of July 2017)

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