Muhammad Nadeem, Muhammad Mustehsan Bashir, Javed Iqbal, Abdul Rasheed.
Primary repair verses colostomy for colonic injuries.
Ann King Edward Med Uni Jan ;10(4):462-5.
Objective: The objectives of this study are to: evaluate the role of primary repair with or without defunctioning colostomy in the management of colonic injury. identify the factors contributing to the outcome in management of colonic injuries. Study Design: Prospective Observational Setting: Surgical Unit IV, DHQ Hospital PMC Faisalabad. Duration: November 2001 to November 2003. Subjects and Methods: The patients of colonic injury presenting at one emergency day were included in primary repair group (n=20) and patient of colonic injury at next emergency day were included in colostomy group (n=20). All patients were aggressively resuscitated and investigated. Colonic injury was suspected on clinical grounds and managed according to standard protocol (vide infra). Associated injures were managed accordingly. Colostomy was closed after three months and all patients were followed for six months complete record was maintained on preformed proforma. Results: Most patients were males and average age in both groups was 28.5 years. Fire arm injury was the top most cause of colonic injury in both groups. In both groups left colon was injured in majority of cases. Maximum time interval between injury and treatment in both groups was within 24 hours. Majority of patients in both groups had associated injuries and commonest injured viscera was small gut. The average hospital stay in primary repair group was half of that in colostomy group. Two patients (10%) in primary repair group who developed complications had right colonic injuries with moderate fecal contamination. In colostomy group ten patients (50%) developed complications majority having left colonic injury with moderate contamination. In majority of the patients who developed complications in both groups the delay was more than 6 hours. There was no mortality in either of the groups. Conclusion: Primary repair of colonic injuries has less morbidity and is less expensive as compared to colostomy and is ideal method of management for colonic injury in patients aggressively resuscitated with no pre existing medical illness.
PakMediNet -Pakistan's largest Database of Pakistani Medical Journals - http://www.pakmedinet.com