CHAPTER 54 COLON AND RECTAL INJURIES
Surgical management of colon and rectal injuries has evolved dramatically since World War II. Accepted treatment at that time generally consisted of resection and end colostomy based on experience with battlefield casualties. Although a difference between civilian and military injuries was recognized, the treatment by civilian trauma surgeons paralleled that of their military counterparts. In the ensuing decades following the Korean and Vietnam wars, primary repair began to replace the “colostomy only” approach in the nonmilitary setting. Numerous prospective randomized trials in civilian centers have since established primary repair as the preferred treatment for most colon and rectal injuries.
ANATOMIC LOCATION AND INJURY GRADING
The Organ Injury Scaling Committee of the American Association of the Surgery of Trauma has developed colon and rectal injury scales that facilitate comparison of injuries between patients and facilities and helps identify patients at high risk for postoperative complications (Tables 1 and 2).
Grade | Injury Description | |
---|---|---|
I | Hematoma | Contusion or hematoma without devascularization |
Laceration | Partial thickness, no perforation | |
II | Laceration | Laceration <50% of circumference |
III | Laceration | Laceration >50% of circumference |
IV | Laceration | Transection of colon |
V | Laceration | Transection with segmental tissue loss |
Note: Advance one grade for multiple injuries up to grade III.
Modified from Organ Injury Scaling Committee of the American Association of the Surgery of Trauma.
Grade | Injury Description | |
---|---|---|
I | Hematoma | Contusion or hematoma without devascularization |
Laceration | Partial thickness, no perforation | |
II | Laceration | Laceration <50% of circumference |
III | Laceration | Laceration >50% of circumference |
IV | Laceration | Full-thickness laceration with extension into perineum |
V | Vascular |