Management of penetrating colon injuries at Kenyatta National Hospital: a critical review of primary closure versus colostomy

Abstract

This is a review of 45 consecutive cases of penetrating injuries of the colon treated at Kenyatta National Hospital from 1986 to 1992. The records of 42 male and 3 female patients (mean age, 28.8 years) were analysed. Injuries were due to stabwounds in 66.7% of patients, and gunshot wounds in 17.8%. Patients with gunshot wounds had other injuries more often than did those with stab wounds, and morbidity and mortality were greater. Thirty two (71.1%) patients underwent primary repair without colostomy. In thirteen (28.9%) a colostomy was constructed. The overall mortality rate for the series was 4.4% and included two patients who died within 24 hours of admission. The overall morbidity rate was 46%, with surgical wound sepsis contributing significantly to the high morbidity. Mortality and morbidity were increased in patients who were in shock when admitted to the hospital, those with other associated injuries, multiple colon injury, increasing transfusion requirement, faecal contamination of the peritoneal cavity, and those delaying by more than 8 hours from injury to operation. Primary closure of the penetrating colon wound was significantly superior to colostomy in terms of morbidity (36.7% vs. 69.2%) and period of hospitalization (13.6 vs. 36.8 day, student's t-test, p less than 0.01). All documented colostomy closures (7 cases) were without mortality but with morbidity rate of 28.6%. In the absence of the above risk factors, the likelihood of infection is low, suggesting that primary repair or resection and anastomosis are safe methods of management of colon injury. When these risk factors are present, the risk of infection is high and colostomy is the preferred method of management. Primary repair should be the mainstay of treatment of stab wounds of the colon, and the skin and subcutaneous tissue of the laparotomy wound should be managed by delayed primary suture or allowed to heal by secondary intent to minimize wound sepsis.