CR34P STOMAS ARE STILL USED IN COLORECTAL TRAUMA

Abstract

Purpose: We aimed to assess the management of colorectal and anal injuries in trauma patients at a single major metropolitan trauma hospital in Australia.Methods: A prospectively collected database at a major metropolitan trauma centre was assessed to retrieve consecutive patients who had colorectal and anal injuries over a 12 year period.Results: 185 patients were identified with colorectal or anal injuries from February 1996 to June 2008. The mechanism of injury was blunt in 145 (78%) with 134 (72%) related to motor vehicle trauma. The remaining 40 (22%) were due to penetrating injuries. There were 165 (89%) colonic injuries, 5 (3%) rectal injuries and 15 (8%) perineal injuries. 106 (57%) patients had multiple site of colonic or multiple organ injuries. 46 (25%) patients had full thickness tear of the colon with only 2 having full transection of the colon. The rest had contusions, serosal tears or mesocolon injury. The median injury severity score was 27 (range 4–75). 134 (72%) patients had surgical intervention including 61 repairs, 30 resections and 12 stomas, 3 of which occurred in major perineal injuries. The in hospital mortality rate was 5.4% with major or minor morbidity occurring in 52%. This included 3 anastomotic leaks and 2 missed injuries requiring a second laparotomy. 12 (6%) patients were subsequently readmitted after the initial management.Conclusion: Colorectal injuries are usually due to road trauma with the majority occurring in the colon and over half these patients have multiple injuries. The complication rate is significant but relatively few of these are related to anastomotic leak when primary anastomosis is undertaken. Stomas however continue to be used.