Stomas and Trauma

Abstract

The use of stomas for the surgical treatment of abdominal trauma has generated controversy for the last two decades as surgeons have questioned the propriety of applying military standards of care to civilian injuries. While diversion has been advocated in the treatment of colon injuries to obviate the potential morbidity associated with anastomotic leak, multiple retrospective and prospective trials have consistently demonstrated improved outcomes with primary repair or resection and anastomosis. Initially, primary repair was proposed only in selected patients without shock, high CIS or ATI scores, or extensive fecal contamination. However, these negative variables contribute to an adverse outcome independent of the type of bowel repair. Colon injury itself logically predisposes patients to increased infectious complications but colostomy may actually increase morbidity, particularly if the risk of subsequent surgery to restore bowel continuity is factored in. High-velocity gunshot wounds are still best treated with diversion.