Evaluation of the Results of Primary Closure/Resection and Primary Anastomosis with Colostomy in Acute Colonic Injured Patients.

Abstract

Background: The management of acute colonic injury has been improved since several decades, treating low risk patients with
primary closure and high risk patients (duration 6 hours or more, shock, contamination, transfusions 6 unit or more and multiple
organs injury) with colostomy.
Objective: To assess the outcomes of primary closure and exteriorization in acute colonic injuries.
Material and Methods: This Comparative study was carried out in the Casualty Department DHQ teaching Hospital Bannu, from
Jan.2009 to Dec.2010. Thirty Eight patients of acute abdominal trauma, who attended the emergency department, were included.
Majority of the patients were those of fire arm injured, followed by blunt abdominal trauma. Less frequent were penetrating trauma
due to stab and bomb blast pieces. As part of their resuscitation, they were shifted to operation theatre for abdominal exploration
and either primary Closure/ Resection and primary anastomosis was done or colostomy of injured colon performed keeping in mind
the Protocol of low and high risk categories respectively. The results obtained were subjected to statistical analysis by using SPSS
software version 20, and showed significant differences except wound infection when compared complications between primary
closure & Colostomy procedures.
Results: Primary Closure was carried out in 18 of 38 patients (47.4%) in low risk category while Colostomy was done in 20 of 38
(52.6%) in high risk patients. (69%) of the patients were below 40 years of their age and (31%) were above 40 years. In our series
fire arm was more common (78.9%) weapon for penetrating abdominal trauma. Isolated Colonic injury was rare 10.6% as colonic
injury was usually associated with other organ injuries (89.4%). Morbidity was comparable in both procedures. Wound infection
recorded was (22%) in Primary Closure & (20%) in Colostomy. Mortality recorded was (5.5%) in Primary Closure & (10%) in
Colostomy patients. Anastomotic leakage was recorded in one patient with primary closure where re colostomy saved the patient.
Mean Hospital stay was 13days.
Conclusion: Primary Closure/Resection and Primary Anastomosis is having good results, in low risk patients but Colostomy of
injured Colon is valuable in high risk and in patients who develop complications after Primary Closure.