A study of the pattern, managementand outcome of penetrating colon injuries in Sagamu

Abstract

Background: Colon injuries are increasingly being treated safely by primary repair in spite of the high risk of septic complications. Objective: This is a retrospective study of the pattern, management and outcome in patients treated for penetrating colon injuries at Olabisi Onabanjo University Teaching Hospital, Sagamu over a 7 year period (January 1995-December 2001). Patients and methods: Records of thirty-two patientswere studied. Results: Gunshots (75 percent) and knife stabs (18.75 percent) accounted for ninety-four percent of penetrating colon injuries. Associated intra-abdominal injuries were present in 22 patients (68.8 percent). Eight (twentyfive percent) patients presented in shock. Moderate to major faecal contamination was present in 30 (93.8%) patients.Severe colon injury occurred in nine patients. The eighteen patients with right colon wounds were managed by primary repair.All the fourteen patientswith left colon wounds had a diverting colostomy alongside repair or resection. Complications included wound infection (56.7 percent) and septicaemia (31.7 percent). Eleven patients died, giving an overallmortality rate of 34.4 percent.Mortalitywas significantly associatedwith shock on admission (p <0.02), degree of faecal contamination (p <0.05) and severity of colon injury ( p<0.01). Colostomy did not affectmortality. ( p<0.1) Conclusion: In this study primary repair was employed in 56% of patients with penetrating colon injuries. The routine use of diverting colostomy for all left colon injuries can no longer be justified in current surgical practice as colostomy did not affectmortality.

Keywords: colon injury; penetrating; colostomy; primary repair;mortality