PATIENT MANAGEMENT GUIDELINES

FOR PENETRATING INTRAPERITONEAL COLON INJURIES

Therapeutic options
 Two stage
 Repair and protective- colostomy

 Resection and stoma formation proximally

• Distal Hartmann’s or mucous fistula

 Exteriorization of repaired bowel – uncommon now

 One stage
 Simple suture repair

 Resection and primary anastamosis

 Trauma grading scores
 Flint grading
 I – isolated colon, no shock, minimal
contamination, minimal delay
 II – Through and through perforation,
laceration, moderate contamination
 III – severe tissue loss, devascularization,
heavy contamination
 Advantage – simplicity
 Disadvantage – does not factor in other
injury
Colon injury scale

ICD-9 AIS-90
Grade* Type of Description of injury
injury

I Haematom Contusion or haematoma without 863.40 - 863.44 2

devascularisation
Laceration Partial thickness, no perforation 863.40 - 863.44
II Laceration Laceration <50% of circumference 863.50 - 863.54 2
3
III Laceration Laceration > 50% of circumference 863.50 - 863.54
without transection
IV Laceration Transection of the colon 3
863.50 - 863.54
V Laceration Transection of the colon with segmental 863.50 - 863.54 4
tissue loss 4

*Advance one grade for multiple injuries up to grade III.

*863.40 / 863.50 = Non-specific site in colon.
863.41 / 863.51 = Ascending. 863.42 / 863.52 = Transverse. 863.43 / 863.53 = Descending. 863.44 /
863.54 = Sigmoid.
From Moore et al. [6]; with permission
 Recommendations

A. Level I : Standard of primary repair

 for nondestructive colon
wounds.(involvement of < 50% of the
bowel wall without devascularization)
 absence of peritonitis.
B. Level II
1. Resection and primary anastomosis .
 Patients with penetrating intraperitoneal colon
wounds which are destructive (involvement of >
50% of the bowel wall or devascularization of a
bowel segment) if they are:
 Hemodynamically stable without evidence of
shock (sustained pre- or intraoperative
hypotension as defined by SBP < 90 mm Hg),
 Have no significant underlying disease,
 Have minimal associated injuries.
 Have no peritonitis.
 2. Managed by resection and colostomy.
Patients with :
shock
underlying disease
significant associated injuries
peritonitis
 3. Colostomies performed following colon and rectal
trauma can be closed within two weeks if contrast
enema is performed to confirm distal colon healing. This
recommendation pertains to patients who do not have
non-healing bowel injury, unresolved wound sepsis, or
are unstable.
 4. A barium enema should not be performed to rule out
colon cancer or polyps prior to colostomy closure for
trauma in patients who otherwise have no indications for
being at risk for colon cancer and or polyps.
 Summary
 Colon trauma carries significant morbidity
and mortality
 Choice of diversion vs. primary repair
should be individualized to situation
 Move towards more primary repairs and
resections with anastomosis without
colostomy
 Right colon = Left colon for management
 Suture>Stapled for trauma?