Patient selection: trauma to colon and/or intraperitoneal rectum
The initial decision is whether a disaster control laparotomy (DCL) is needed.
If DCL is needed, then it is performed with a later relaparotomy to repair, resect and re-anastomose.
Colostomy and proximal diversion should be considered at the re-laparotomy after DCL if there is:
(1) ongoing shock and acidosis
(2) pancreatic and/or genitourinary injuries
(3) major chronic disease
(4) immunosuppression
(5) compromised perfusion
(6) inability to close fascia at the second laparotomy
If DCL is not needed, then the second decision is whether to perform a primary repair.
If not, then a resection and re-anastomosis is performed.
Colostomy and proximal diversion after resection and re-anastomosis should be considered if there is:
(1) compromised perfusion
(2) compromised healing of the anastomosis
(3) unfavorable local environment for healing
