Patient selection: colon trauma
Criteria for immediate management - all of the following:
(1) hemodynamically stable
(2) pH > 7.2
(3) body temperature > 33°C
(4) no evidence of coagulopathy
If the patient does not meet the criteria for immediate management, then:
(1) use a GIA stapler to close both sides of the colon injury
(2) resuscitate the patient in the ICU
(3) bring the patient back to surgery once stabilized
Parameters used in decision making:
(1) location of injury proximal to middle colic artery
(2) need for resection
(3) patient's condition
Indications for colon resection:
(1) mesenteric injury with nonviable tissue
(2) transection from bullet or shotgun pellets
(3) injury to >= 50% of bowel circumference
(4) multiple perforations close together
If the injury is simple and does not need to be resected, then it can be suture repaired.
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Relationship of Injury to Middle Colic Artery
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Patient Condition
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Operation
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proximal
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NA
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resect and ileocolostomy
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at or distal
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good and meet criteria for immediate management
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resect and colocolostomy
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at or distal
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poor or delayed management
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end colostomy
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