ABSTRACT
The use of stomas for the surgical treatment of abdominal trauma has generated controversy
for the last two decades as surgeons have questioned the propriety of applying military
standards of care to civilian injuries. While diversion has been advocated in the
treatment of colon injuries to obviate the potential morbidity associated with anastomotic
leak, multiple retrospective and prospective trials have consistently demonstrated
improved outcomes with primary repair or resection and anastomosis. Initially, primary
repair was proposed only in selected patients without shock, high CIS or ATI scores,
or extensive fecal contamination. However, these negative variables contribute to
an adverse outcome independent of the type of bowel repair. Colon injury itself logically
predisposes patients to increased infectious complications but colostomy may actually
increase morbidity, particularly if the risk of subsequent surgery to restore bowel
continuity is factored in. High-velocity gunshot wounds are still best treated with
diversion.
KEYWORDS
ATI (abdominal trauma index) - CIS (colon injury score) - colon injury - colostomy
- anastomosis - prospective randomized trial - gunshot wounds