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2017 ; 2
(1
): e000092
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Evolution of the operative management of colon trauma
#MMPMID29766094
Sharpe JP
; Magnotti LJ
; Fabian TC
; Croce MA
Trauma Surg Acute Care Open
2017[]; 2
(1
): e000092
PMID29766094
show ga
For any trauma surgeon, colon wounds remain a relatively common, yet sometimes
challenging, clinical problem. Evolution in operative technique and improvements
in antimicrobial therapy during the past two centuries have brought remarkable
improvements in both morbidity and mortality after injury to the colon. Much of
the early progress in management and patient survival after colon trauma evolved
from wartime experience. Multiple evidence-based studies during the last several
decades have allowed for more aggressive management, with most wounds undergoing
primary repair or resection and anastomosis with an acceptably low suture line
failure rate. Despite the abundance of quality evidence regarding management of
colon trauma obtained from both military and civilian experience, there remains
some debate among institutions regarding management of specific injuries. This is
especially true with respect to destructive wounds, injuries to the left colon,
blunt colon trauma and those wounds requiring colonic discontinuity during an
abbreviated laparotomy. Some programs have developed data-driven protocols that
have simplified management of destructive colon wounds, clearly identifying those
high-risk patients who should undergo diversion, regardless of mechanism or
anatomic location. This update will describe the progression in the approach to
colon injuries through history while providing a current review of the literature
regarding management of the more controversial wounds.