Open AccessImproving Outcomes Following Penetrating Colon Wounds
Author(s) -
Preston R. Miller,
Timothy C. Fabian,
Martin A. Croce,
Louis J. Magnotti,
F E Pritchard,
Gayle Minard,
Ronald M. Stewart
Publication year - 2002
Publication title -
annals of surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 4.153
H-Index - 309
eISSN - 1528-1140
pISSN - 0003-4932
DOI - 10.1097/00000658-200206000-00004
Subject(s) - medicine , colostomy , penetrating trauma , surgery , anastomosis , packed red blood cells , blood transfusion , fibrous joint , general surgery , blunt
During World War II, failure to treat penetrating colon injuries with diversion could result in court martial. Based on this wartime experience, colostomy for civilian colon wounds became the standard of care for the next 4 decades. Previous work from our institution demonstrated that primary repair was the optimal management for nondestructive colon wounds. Optimal management of destructive wounds requiring resection remains controversial. To address this issue, we performed a study that demonstrated risk factors (pre or intraoperative transfusion requirement of more than 6 units of packed red blood cells, significant comorbid diseases) that were associated with a suture line failure rate of 14%, and of whom 33% died. Based on these outcomes, a clinical pathway for management of destructive colon wounds was developed. The results of the implementation of this pathway are the focus of this report.