The approach to patients who have sustained colon trauma has changed dramatically over the last several decades. This has been associated with a significant improvement in colon-related mortality from approximately 60% during World War I to 40% during World War II, 10% during the Vietnam War and even lower in the current era. Colon-related morbidity, however, still remains high and in most prospective studies the abdominal sepsis rate is approximately 20% (Table 33-1).1,2,3,4,5,6,7 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%.8,9
TABLE 33-1Incidence of Abdominal Septic Complications in Colon Injuries (Prospective Studies) ||Download (.pdf) TABLE 33-1 Incidence of Abdominal Septic Complications in Colon Injuries (Prospective Studies)
|Author ||Number of patients ||Abdominal sepsis (%) |
|George et al1 ||102 ||33 |
|Chappuis et al2 || 56 ||20 |
|Demetriades et al3 ||100 ||16 |
|Ivatury et al4 ||252 ||17 |
|Gonzalez et al5 ||114 ||24 |
|Demetriades et al6 ||297 ||24 |
|Overall ||921 ||22 |
In the United States, the overall incidence of blunt and penetrating trauma remains similar7; however, this will vary depending on the center's incoming demographic. In general, blunt trauma patients can be expected to be older, have a higher total burden of injury and endure longer hospital stays with a higher mortality and complication rate.7 In abdominal gunshot wounds the colon is the second most commonly injured organ after the small bowel and is involved in approximately 27% of cases undergoing laparotomy.10,11 In anterior abdominal stab wounds the colon is the third most commonly injured organ after the liver and small bowel and is found in approximately 18% of patients undergoing laparotomy. In posterior stab wounds the colon is the most commonly injured organ and is seen in about 20% of patients undergoing laparotomy.12 The right colon is most frequently injured after blunt force trauma7 whereas the transverse colon is the most commonly injured segment after gunshot wounds and the left colon the most commonly injured segment after stab wounds.
Stab wounds or low-velocity civilian gunshot wounds usually cause limited damage and most 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).
Low-velocity gunshot wounds cause local damage to the colon.
High-velocity destructive injury to the colon.