The management of colon injuries.

Surgical management of colon injuries was assessed in 97 patients. Injuries comprised stab wounds (88 cases), blunt trauma (5 cases), and gunshot wounds (4 cases). Injury involved the right colon in 52,6% and the left colon in 47,4% of patients. Fifty-eight per cent had associated major visceral injury. Patients were divided into two categories; those in whom proximal colostomy or exteriorisation of the perforation was performed constituted the one group, and those who had primary closure, the other. Analysis of results were made with regard to the incidence of wound infection, intra-abdominal abscess formation, peritonitis, and other postoperative complications. Seventeen patients had exteriorisation of the colon performed. Colostomy and colostomy closure had a significant morbidity rate, with a mean total period of hospitalisation of 58,5 days. Eighty patients were treated by primary closure. Septic complications occurred in 36,7% of cases. An analysis of the factors influencing mortality and morbidity was made, with reference to the side of the colon involved, the time interval between injury and surgery, faecal contamination of the peritoneal cavity, associated visceral injury and the presence of more than one colonic perforation. Increased morbidity was noted when the operative delay exceeded 6 hours and when faecal contamination of the peritoneal cavity was marked. Primary closure of a lacerated colon is safe provided that careful consideration is given to the above factors.