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Introduction

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The management of colon injuries has undergone many radical changes in the last few decades, resulting in a dramatic reduction of colon-related mortality from about 60% during World War I to about 40% during World War II to about 10% during the Vietnam War and to lower than 3% in the last decade. However, the colon-related morbidity remains unacceptably high and in most prospective studies the abdominal sepsis rate is about 20% (Table 33-1).16 In patients with destructive colon injuries, high Penetrating Abdominal Trauma Index (PATI), or multiple blood transfusions the incidence of intra-abdominal sepsis has been reported to be as high as 27%.7,8

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Table 33-1 Incidence of Abdominal Septic Complications in Colon Injuries (Prospective Studies) 
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Epidemiology

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In the United States, the vast majority of colon injuries are due to penetrating trauma, usually firearms. In abdominal gunshot wounds the colon is the second most commonly injured organ after the small bowel and it is involved in about 27% of cases undergoing laparotomy.8,9 In anterior abdominal stab wounds the colon is the third most commonly injured organ after the liver and small bowel and is found in about 18% of patients undergoing laparotomy. In posterior stab wounds the colon is the most commonly injured organ and is diagnosed in about 20% of patients undergoing laparotomy.10 The transverse colon is the most commonly injured segment after gunshot wounds and the left colon the most commonly injured segment after stab wounds.

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Stab wounds or low-velocity civilian gunshot wounds usually cause limited damage and most of them are amenable to debridement and primary repair (Fig. 33-1). High-velocity penetrating injuries, such as in war-related trauma, cause major tissue damage and almost always require colon resection (Fig. 33-2).

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Figure 33-1
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Low-velocity gunshot wounds cause local damage to the colon.

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Figure 33-2
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High-velocity destructive injury to the colon.

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Blunt trauma to the colon is uncommon and occurs in about 0.5% of all major blunt trauma admissions or in 10.6% of patients undergoing laparotomy.11,12 Most of these injuries are superficial and only 3% of patients undergoing laparotomy have full-thickness colon perforations.11,13 Traffic trauma is the most common cause of blunt ...

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