Historical and Current Trends in Colon Trauma

Abstract

The authors discuss the evolution of the evaluation and management of colonic trauma, as well as the debate regarding primary repair versus fecal diversion. Their evidence-based review covers diagnosis, management, surgical approaches, and perioperative care of patients with colon-related trauma. The management of traumatic colon injuries has evolved significantly over the past 50 years; here the authors describe a practical approach to the treatment and management of traumatic injuries to the colon based on the most current research. However, management of traumatic colon injuries remains a challenge and continues to be associated with significant morbidity. Familiarity with the different methods to the approach and management of colonic injuries will allow surgeons to minimize unnecessary complications and mortality.

Keywords

colon trauma - colon injury - damage control laparotomy - perioperative colon trauma care

• References

• 1 New International Version. Bible.
• 2 Welling DR, Duncan JE. Stomas and trauma. Clin Colon Rectal Surg 2008; 21 (1) 45-52
• 3 Fraser J, Drummond H. A clinical and experimental study of three hundred perforating wounds of the abdomen. BMJ 1917; 1 (2932) 321-330
• 4 Imes PR. War surgery of the abdomen. Surg Gynecol Obstet 1945; 81 (21005308) 608-616
• 5 Miller PR, Fabian TC, Croce MA , et al. Improving outcomes following penetrating colon wounds: application of a clinical pathway. Ann Surg 2002; 235 (6) 775-781
• 6 Ogilvie WH. Surgical lessons of war applied to civil practice. BMJ 1945; 1 (4400) 619-623
• 7 Edwards DP, Galbraith KA. Colostomy in conflict: military colonic surgery. Ann R Coll Surg Engl 1997; 79 (4) 243-244
• 8 Woodhall JP, Ochsner A. The management of perforating injuries of the colon and rectum in civilian practice. Surgery 1951; 29 (2) 305-320
• 9 Stone HH, Fabian TC. Management of perforating colon trauma: randomization between primary closure and exteriorization. Ann Surg 1979; 190 (4) 430-436
• 10 Burch JM, Feliciano DV, Mattox KL. Colostomy and drainage for civilian rectal injuries: is that all?. Ann Surg 1989; 209 (5) 600-610 , discussion 610–611
• 11 al-Qasabi QO, Katugampola W, Singh ND. Management of colon injuries. Injury 1991; 22 (1) 32-34
• 12 Demetriades D. Penetrating injuries of the colon—changing perspectives. S Afr J Surg 1991; 29 (1) 25-25
• 13 Pachter HL, Hoballah JJ, Corcoran TA, Hofstetter SR. The morbidity and financial impact of colostomy closure in trauma patients. J Trauma 1990; 30 (12) 1510-1513
• 14 Strada G, Raad L, Belloni G, Setti Carraro P. Large bowel perforations in war surgery: one-stage treatment in a field hospital. Int J Colorectal Dis 1993; 8 (4) 213-216
• 15 George Jr SM, Fabian TC, Voeller GR, Kudsk KA, Mangiante EC, Britt LG. Primary repair of colon wounds. A prospective trial in nonselected patients. Ann Surg 1989; 209 (6) 728-733 , 733–734
• 16 Curran TJ, Borzotta AP. Complications of primary repair of colon injury: literature review of 2,964 cases. Am J Surg 1999; 177 (1) 42-47
• 17 Brady RR, O'Neill S, Berry O, Kerssens JJ, Yalamarthi S, Parks RW. Traumatic injury to the colon and rectum in Scotland: demographics and outcome. Colorectal Dis 2012;14(1):e16–e22
• 18 Hudolin T, Hudolin I. The role of primary repair for colonic injuries in wartime. Br J Surg 2005; 92 (5) 643-647
• 19 Uravić M. Colorectal war injuries. Mil Med 2000; 165 (3) 186-188
• 20 Steele SR, Wolcott KE, Mullenix PS , et al. Colon and rectal injuries during Operation Iraqi Freedom: are there any changing trends in management or outcome?. Dis Colon Rectum 2007; 50 (6) 870-877
• 21 Cho SD, Kiraly LN, Flaherty SF, Herzig DO, Lu KC, Schreiber MA. Management of colonic injuries in the combat theater. Dis Colon Rectum 2010; 53 (5) 728-734
• 22 Steel M, Danne P, Jones I. Colon trauma: Royal Melbourne Hospital experience. ANZ J Surg 2002; 72 (5) 357-359
• 23 Slim MS, Makaroun M, Shammá AR. Primary repair of colorectal injuries in childhood. J Pediatr Surg 1981; 16 (6) 1008-1011
• 24 Williams MD, Watts D, Fakhry S. Colon injury after blunt abdominal trauma: results of the EAST Multi-Institutional Hollow Viscus Injury Study. J Trauma 2003; 55 (5) 906-912
• 25 Ng AKT, Simons RK, Torreggiani WC, Ho SGF, Kirkpatrick AW, Brown DRG. Intra-abdominal free fluid without solid organ injury in blunt abdominal trauma: an indication for laparotomy. J Trauma 2002; 52 (6) 1134-1140
• 26 Govender M, Madiba TE. Current management of large bowel injuries and factors influencing outcome. Injury 2010; 41 (1) 58-63
• 27 Talton DS, Craig MH, Hauser CJ, Poole GV. Major gastroenteric injuries from blunt trauma. Am Surg 1995; 61 (1) 69-73
• 28 Chanson C, Nassiopoulos K, Kiesler P, Petropoulos P. [Trauma to the colon in civilian surgery]. Swiss Surg 1998; (5) 244-248
• 29 Towne JB, Coe JD. Seat belt trauma of the colon. Am J Surg 1971; 122 (5) 683-685
• 30 Halvorsen JF, Vagn Nielsen O, Bugge-Asperheim B. Injures of the colon and rectum. Ann Chir Gynaecol 1981; 70 (5) 287-291
• 31 Welling DR, Hutton JE, Minken SL, Place RJ, Burris DG. Diversion defended—military colon trauma. J Trauma 2008; 64 (4) 1119-1122
• 32 Vannix RS, Carter R, Hinshaw DB, Joergenson EJ. Surgical management of colon trauma in civilian practice. Am J Surg 1963; 106: 364-371
• 33 Ogilvie I, Wilkens S, Rodgers AJ, Aggeler R, Capaldi RA. The second stalk: the delta-b subunit connection in ECF1F0. Acta Physiol Scand Suppl 1998; 643: 169-175
• 34 Eshraghi N, Mullins RJ, Mayberry JC, Brand DM, Crass RA, Trunkey DD. Surveyed opinion of American trauma surgeons in management of colon injuries. J Trauma 1998; 44 (1) 93-97
• 35 American College of Surgeons. Advanced trauma life support. Chicago, IL: American College of Surgeons; 2008
• 36 Udobi KF, Rodriguez A, Chiu WC, Scalea TM. Role of ultrasonography in penetrating abdominal trauma: a prospective clinical study. J Trauma 2001; 50 (3) 475-479
• 37 Martin MM, Willardson BM, Burton GF , et al. Human angiotensin II type 1 receptor isoforms encoded by messenger RNA splice variants are functionally distinct. Mol Endocrinol 2001; 15 (2) 281-293
• 38 Johnson EK, Judge T, Lundy J, Meyermann M. Diagnostic pelvic computed tomography in the rectal-injured combat casualty. Mil Med 2008; 173 (3) 293-299
• 39 Shanmuganathan K, Mirvis SE, Chiu WC, Killeen KL, Scalea TM. Triple-contrast helical CT in penetrating torso trauma: a prospective study to determine peritoneal violation and the need for laparotomy. AJR Am J Roentgenol 2001; 177 (6) 1247-1256
• 40 Shanmuganathan K, Mirvis SE, Chiu WC, Killeen KL, Hogan GJF, Scalea TM. Penetrating torso trauma: triple-contrast helical CT in peritoneal violation and organ injury—a prospective study in 200 patients. Radiology 2004; 231 (3) 775-784
• 41 Otomo Y, Henmi H, Mashiko K , et al. New diagnostic peritoneal lavage criteria for diagnosis of intestinal injury. J Trauma 1998; 44 (6) 991-997 , discussion 997–999
• 42 Henneman PL, Marx JA, Moore EE, Cantrill SV, Ammons LA. Diagnostic peritoneal lavage: accuracy in predicting necessary laparotomy following blunt and penetrating trauma. J Trauma 1990; 30 (11) 1345-1355
• 43 García JJ, Ogilvie I, Robinson BH, Capaldi RA. Structure, functioning, and assembly of the ATP synthase in cells from patients with the T8993G mitochondrial DNA mutation. Comparison with the enzyme in Rho(0) cells completely lacking MTDNA. J Biol Chem 2000; 275 (15) 11075-11081
• 44 Islam NC, Wood KB, Transfeldt EE , et al. Extension of fusions to the pelvis in idiopathic scoliosis. Spine 2001; 26 (2) 166-173
• 45 Ogilvie CM, Kasten P, Rovinsky D, Workman KL, Johnston JO. Cysticercosis of the triceps—an unusual pseudotumor: case report and review. Clin Orthop Relat Res 2001; (382) 217-221
• 46 Leibman NF, Lana SE, Hansen RA , et al. Identification of matrix metalloproteinases in canine cutaneous mast cell tumors. J Vet Intern Med 2000; 14 (6) 583-586
• 47 Abcarian H. Rectal trauma. Gastroenterol Clin North Am 1987; 16 (1) 115-123
• 48 Baako BN, Badoe EA. Gallstone impaction in the duodenal bulb: an uncommon cause of gastric outlet obstruction associated with gallstone emesis. West Afr J Med 1998; 17 (2) 124-127
• 49 Morris DS, Sugrue WJ. Abdominal injuries in the war wounded of Afghanistan: a report from the International Committee of the Red Cross Hospital in Kabul. Br J Surg 1991; 78 (11) 1301-1304
• 50 Chappuis CW, Frey DJ, Dietzen CD, Panetta TP, Buechter KJ, Cohn Jr I. Management of penetrating colon injuries. A prospective randomized trial. Ann Surg 1991; 213 (5) 492-497 , discussion 497–498
• 51 Berne JD, Velmahos GC, Chan LS, Asensio JA, Demetriades D. The high morbidity of colostomy closure after trauma: further support for the primary repair of colon injuries. Surgery 1998; 123 (2) 157-164
• 52 Jacobson LE, Gomez GA, Broadie TA. Primary repair of 58 consecutive penetrating injuries of the colon: should colostomy be abandoned?. Am Surg 1997; 63 (2) 170-177
• 53 Sasaki LS, Allaben RD, Golwala R, Mittal VK. Primary repair of colon injuries: a prospective randomized study. J Trauma 1995; 39 (5) 895-901
• 54 Gonzalez RP, Merlotti GJ, Holevar MR. Colostomy in penetrating colon injury: is it necessary?. J Trauma 1996; 41 (2) 271-275
• 55 Durham RM, Pruitt C, Moran J, Longo WE. Civilian colon trauma: factors that predict success by primary repair. Dis Colon Rectum 1997; 40 (6) 685-692
• 56 Miller BJ, Schache DJ. Colorectal injury: where do we stand with repair?. Aust N Z J Surg 1996; 66 (6) 348-352
• 57 Pasquale M, Fabian TC. Practice management guidelines for trauma from the Eastern Association for the Surgery of Trauma. J Trauma 1998; 44 (6) 941-956 , discussion 956–957
• 58 Mickevicius A, Klizaite J, Tamelis A, Saladzinskas Z, Pavalkis D. [Penetrating colorectal trauma: index of severity and results of treatment]. Medicina (Kaunas) 2003; 39 (6) 562-569
• 59 Stewart RM, Fabian TC, Croce MA, Pritchard FE, Minard G, Kudsk KA. Is resection with primary anastomosis following destructive colon wounds always safe?. Am J Surg 1994; 168 (4) 316-319
• 60 Maxwell RA, Fabian TC. Current management of colon trauma. World J Surg 2003; 27 (6) 632-639
• 61 Kamwendo NY, Modiba MCM, Matlala NS, Becker PJ. Randomized clinical trial to determine if delay from time of penetrating colonic injury precludes primary repair. Br J Surg 2002; 89 (8) 993-998
• 62 Payravi H, Mortaz SS, Fazel I. Surgical treatment results of Iranian abdominal trauma casualties in the Iran and Iraq war. Mil Med 2001; 166 (11) 952-954
• 63 Saghafinia M, Nafissi N, Motamedi MRK , et al. Assessment and outcome of 496 penetrating gastrointestinal warfare injuries. J R Army Med Corps 2010; 156 (1) 25-27
• 64 Duncan JE, Corwin CH, Sweeney WB , et al. Management of colorectal injuries during Operation Iraqi Freedom: patterns of stoma usage. J Trauma 2008; 64 (4) 1043-1047
• 65 Vertrees A, Wakefield M, Pickett C , et al. Outcomes of primary repair and primary anastomosis in war-related colon injuries. J Trauma 2009; 66 (5) 1286-1291 , discussion 1291–1293
• 66 Stankovic N, Petrovic M, Drinkovic N, Bjelovic M, Jevtic M, Mirkovic D. Colon and rectal war injuries. J Trauma 1996; 40 (3, Suppl) S183-S188
• 67 Demetriades D, Murray JA, Chan L , et al; Committee on Multicenter Clinical Trials. American Association for the Surgery of Trauma. Penetrating colon injuries requiring resection: diversion or primary anastomosis? An AAST prospective multicenter study. J Trauma 2001; 50 (5) 765-775
• 68 Cleary RK, Pomerantz RA, Lampman RM. Colon and rectal injuries. Dis Colon Rectum 2006; 49 (8) 1203-1222
• 69 Demetriades D, Murray JA, Chan LS , et al. Handsewn versus stapled anastomosis in penetrating colon injuries requiring resection: a multicenter study. J Trauma 2002; 52 (1) 117-121
• 70 Adesanya AA, Ekanem EE. A ten-year study of penetrating injuries of the colon. Dis Colon Rectum 2004; 47 (12) 2169-2177
• 71 Singer MA, Nelson RL. Primary repair of penetrating colon injuries: a systematic review. Dis Colon Rectum 2002; 45 (12) 1579-1587
• 72 Nelson R, Singer M. Primary repair for penetrating colon injuries. Cochrane Database Syst Rev 2003; (3) CD002247
• 73 Ogilvie GK. Dolasetron: a new option for nausea and vomiting. J Am Anim Hosp Assoc 2000; 36 (6) 481-483
• 74 Fontes Jr RA, Ogilvie CM, Miclau T. Necrotizing soft-tissue infections. J Am Acad Orthop Surg 2000; 8 (3) 151-158
• 75 DuBose J. Colonic trauma: indications for diversion vs. repair. J Gastrointest Surg 2009; 13 (3) 403-404
• 76 Thompson JS, Moore EE, Moore JB. Comparison of penetrating injuries of the right and left colon. Ann Surg 1981; 193 (4) 414-418
• 77 Eshraghi N, Mullins RJ, Mayberry JC, Brand DM, Crass RA, Trunkey DD. Surveyed opinion of American trauma surgeons in management of colon injuries. J Trauma 1998; 44 (1) 93-97
• 78 Murray JA, Demetriades D, Colson M , et al. Colonic resection in trauma: colostomy versus anastomosis. J Trauma 1999; 46 (2) 250-254
• 79 Fealk M, Osipov R, Foster K, Caruso D, Kassir A. The conundrum of traumatic colon injury. Am J Surg 2004; 188 (6) 663-670
• 80 Ogilvie KM, Held Hales K, Roberts ME, Hales DB, Rivier C. The inhibitory effect of intracerebroventricularly injected interleukin 1beta on testosterone secretion in the rat: role of steroidogenic acute regulatory protein. Biol Reprod 1999; 60 (2) 527-533
• 81 Zacharias SR, Offner P, Moore EE, Burch J. Damage control surgery. AACN Clin Issues 1999; 10 (1) 95-103 , quiz 141–142
• 82 Adams JM, Hauser CJ, Livingston DH , et al. The immunomodulatory effects of damage control abdominal packing on local and systemic neutrophil activity. J Trauma 2001; 50 (5) 792-800
• 83 Cotton BA, Reddy N, Hatch QM , et al. Damage control resuscitation is associated with a reduction in resuscitation volumes and improvement in survival in 390 damage control laparotomy patients. Ann Surg 2011; 254 (4) 598-605
• 84 Valerius KD, Ogilvie GK, Fettman MJ , et al. Comparison of the effects of asparaginase administered subcutaneously versus intramuscularly for treatment of multicentric lymphoma in dogs receiving doxorubicin. J Am Vet Med Assoc 1999; 214 (3) 353-356
• 85 Ogilvie MD, Hilton CE, Ogilvie CD. Lumbar anomalies in the Shanidar 3 Neandertal. J Hum Evol 1998; 35 (6) 597-610
• 86 McPartland KJ, Hyman NH. Damage control: what is its role in colorectal surgery?. Dis Colon Rectum 2003; 46 (7) 981-986
• 87 Miller PR, Chang MC, Hoth JJ, Holmes IV JH, Meredith JW. Colonic resection in the setting of damage control laparotomy: is delayed anastomosis safe?. Am Surg 2007; 73 (6) 606-609 , discussion 609–610
• 88 Weinberg JA, Griffin RL, Vandromme MJ , et al. Management of colon wounds in the setting of damage control laparotomy: a cautionary tale. J Trauma 2009; 67 (5) 929-935
• 89 Ott MM, Norris PR, Diaz JJ , et al. Colon anastomosis after damage control laparotomy: recommendations from 174 trauma colectomies. J Trauma 2011; 70 (3) 595-602
• 90 Smallman-Raynor MR, Cliff AD. Impact of infectious diseases on war. Infect Dis Clin North Am 2004; 18 (2) 341-368
• 91 Kirton OC, O'Neill PA, Kestner M, Tortella BJ. Perioperative antibiotic use in high-risk penetrating hollow viscus injury: a prospective randomized, double-blind, placebo-control trial of 24 hours versus 5 days. J Trauma 2000; 49 (5) 822-832
• 92 Bozorgzadeh A, Pizzi WF, Barie PS , et al. The duration of antibiotic administration in penetrating abdominal trauma. Am J Surg 1999; 177 (2) 125-131
• 93 Fabian TC, Croce MA, Payne LW, Minard G, Pritchard FE, Kudsk KA. Duration of antibiotic therapy for penetrating abdominal trauma: a prospective trial. Surgery 1992; 112 (4) 788-794 , discussion 794–795
• 94 Luchette FA, Borzotta AP, Croce MA , et al. Practice management guidelines for prophylactic antibiotic use in penetrating abdominal trauma: the EAST Practice Management Guidelines Work Group. J Trauma 2000; 48 (3) 508-518
• 95 Fullen WD, Hunt J, Altemeier WA. The clinical spectrum of penetrating injury to the superior mesenteric arterial circulation. J Trauma 1972; 12 (8) 656-664
• 96 Thadepalli H, Gorbach SL, Broido PW, Norsen J, Nyhus L. Abdominal trauma, anaerobes, and antibiotics. Surg Gynecol Obstet 1973; 137 (2) 270-276
• 97 Hospenthal DR, Murray CK, Andersen RC , et al. Guidelines for the prevention of infection after combat-related injuries. J Trauma 2008; 64 (18316965) 211-220
• 98 Ogilvie TH. Deans respond to task force report “opportunity for renewal.”. Can Vet J 1999; 40 (2) 89-93
• 99 Schnüriger B, Inaba K, Wu T, Eberle BM, Belzberg H, Demetriades D. Crystalloids after primary colon resection and anastomosis at initial trauma laparotomy: excessive volumes are associated with anastomotic leakage. J Trauma 2011; 70 (3) 603-610
• 100 Renz BM, Feliciano DV. Unnecessary laparotomies for trauma: a prospective study of morbidity. J Trauma 1995; 38 (3) 350-356
• 101 Hollinshead WH. Embryology and surgical anatomy of the colon. Dis Colon Rectum 1962; 5: 23-27
• 102 Ogilvie K, Rivier C. The intracerebroventricular injection of interleukin-1beta blunts the testosterone response to human chorionic gonadotropin: role of prostaglandin- and adrenergic-dependent pathways. Endocrinology 1998; 139 (7) 3088-3095
• 103 Risdon C, Ogilvie G. A fellowship in the population-centered clinical method. Acad Med 1998; 73 (5) 600-601
• 104 Agaba EA, Zaidi RM, Ramzy P , et al. Laparoscopic Hartmann's procedure: a viable option for treatment of acutely perforated diverticulitis. Surg Endosc 2009; 23 (7) 1483-1486
• 105 Causey MW, Oguntoye M, Steele SR. Incidence of complications following colectomy with mesenteric closure versus no mesenteric closure: does it really matter?. J Surg Res 2011; 171 (2) 571-575
• 106 Voyles CR, Flint Jr LM. Wound management after trauma to the colon. South Med J 1977; 70 (9) 1067-1069
• 107 Yang HT, Ogilvie RW, Terjung RL. Exercise training enhances basic fibroblast growth factor-induced collateral blood flow. Am J Physiol 1998; 274 (6 Pt 2) H2053-H2061
• 108 Ogilvie GK. Chemotherapy and the surgery patient: principles and recent advances. Clin Tech Small Anim Pract 1998; 13 (1) 22-32
• 109 Dente CJ, Tyburski J, Wilson RF, Collinge J, Steffes C, Carlin A. Ostomy as a risk factor for posttraumatic infection in penetrating colonic injuries: univariate and multivariate analyses. J Trauma 2000; 49 (4) 628-634 , discussion 634–637
• 110 Orsay CP, Merlotti G, Abcarian H, Pearl RK, Nanda M, Barrett J. Colorectal trauma. Dis Colon Rectum 1989; 32 (3) 188-190
• 111 Kaiser AM, Israelit S, Klaristenfeld D , et al. Morbidity of ostomy takedown. J Gastrointest Surg 2008; 12 (3) 437-441
• 112 Vermeulen J, Coene PP, Van Hout NM , et al. Restoration of bowel continuity after surgery for acute perforated diverticulitis: should Hartmann's procedure be considered a one-stage procedure?. Colorectal Dis 2009; 11 (6) 619-624
• 113 Mileski WJ, Rege RV, Joehl RJ, Nahrwold DL. Rates of morbidity and mortality after closure of loop and end colostomy. Surg Gynecol Obstet 1990; 171 (1) 17-21
• 114 Pachter HL, Hoballah JJ, Corcoran TA, Hofstetter SR. The morbidity and financial impact of colostomy closure in trauma patients. J Trauma 1990; 30 (12) 1510-1513
• 115 Bell C, Asolati M, Hamilton E , et al. A comparison of complications associated with colostomy reversal versus ileostomy reversal. Am J Surg 2005; 190 (5) 717-720
• 116 Ogilvie G, Walsh A, Rice S. The problem-based medical audit program: influence on family practice residents' knowledge and skills. Fam Med 1998; 30 (6) 417-420
• 117 Thal ER, Yeary EC. Morbidity of colostomy closure following colon trauma. J Trauma 1980; 20 (4) 287-291
• 118 Bulger EM, McMahon K, Jurkovich GJ. The morbidity of penetrating colon injury. Injury 2003; 34 (1) 41-46
• 119 Crass RA, Salbi F, Trunkey DD. Colostomy closure after colon injury: a low-morbidity procedure. J Trauma 1987; 27 (11) 1237-1239
• 120 Taheri PA, Ferrara JJ, Johnson CE, Lamberson KA, Flint LM. A convincing case for primary repair of penetrating colon injuries. Am J Surg 1993; 166 (1) 39-44
• 121 Khalid MS, Moeen S, Khan AW, Arshad R, Khan AFA. Same admission colostomy closure: a prospective, randomised study in selected patient groups. Surgeon 2005; 3 (1) 11-14