Management Recommendation of Govender and Madiba for a Patient with Injuries to the Large Bowel

 

Management of the patient:

(1) Resuscitate.

(2) Identify colonic injury on laparotomy.

(3) Identify rectal injury in a patient with transpelvic trauma (via proctosigmoidoscopy, laparoscopy, laparotomy or other technique).

 

Types of injuries:

(1) destructive injuries to the colon

(2) non-destructive injury to the colon

(3) intra-peritoneal rectal injury

(4) extra-peritoneal rectal injury

Type of Injury	Recommendation
destructive injury to colon	resect damaged segment and perform anastomosis
non-destructive injury to the colon	primary repair
intra-peritoneal rectal injury	primary repair and perform anastomosis
extra-peritoneal rectal injury	colostomy with or without peritoneal drain

 

where:

• The use of a presacral drain for an extraperitoneal rectal injury is controversial.