Burch described an algorithm for management of traumatic colon injuries. The author is from the University of Colorado in Denver.


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.


Relationship of Injury to Middle Colic Artery

Patient Condition




resect and ileocolostomy

at or distal

good and meet criteria for immediate management

resect and colocolostomy

at or distal

poor or delayed management

end colostomy


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