Algorithm of Sharpe et al for a Patient with a Penetrating Colon Injury

Sharpe et al used an algorithm to manage patients with penetrating trauma to the colon. The authors are from the University of Tennessee

Patient selection: penetrating trauma to the colon (full thickness)

Parameters:

(1) destructive vs nondestructive lesion

(2) volume of blood transfused before or during surgery

(3) comorbidity associated with impaired wound healing (HIV, heart failure, renal failure, cirrhosis, chronic steroid therapy)

Destuctive lesions involved one or more of the following:

(1) complete transection

(2) wound involving more than 50% of the wall circumference

(3) significant tissue loss

(4) devascularized segment

Type of Lesion	Comorbidity and/or >= 6 Units PRBCs Transfused	Management
nondestructive	NA	primary repair
destructive	no	resection with anastomosis
destructive	yes	diversion colostomy

where:

• The presence of a destructive lesion with comorbidity and/or >= 6 units transfused was considered high risk.

• Suture line failure following anastomosis was more common in patients with a higher abdominal AIS.

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