The injured colon: therapeutic considerations.

A prospective randomized study was carried out at the Detroit General Hospital over a two year period to evaluate methods of management in 165 patients with colonic injuries. Results of the study show that primary closure is a safe and reiable method of management when rigid criteria are incorporated in an ongoing protocol. Moreover, the technic of exteriorization is a safe adjunct to management and is recommended in any patient with a colonic injury above 18 cm in which one suture line is required and in which the additional operating time of twenty minutes will not compromise the management of secondary injuries. Patients not fulfilling these criteria should have primary colostomy. These principles make it possible to reduce the need for primary colostomy to approximately 50 per cent in a large ongoing group of patients with colonic injury.