The role of enterostomy in the management of colonic injuries

Abstract

The circumstances, evaluation and results of the management of 67 colonic and rectal injuries during the period 1992-2003 in Clinical Centre of Podgorica are presented. In 32 war and 37 civilian injuries to colon, several systems of the severity trauma determination, as well as systems of grading and classification of injuries of colon were evaluated, and the surgical access according to achieved results was investigated in order to determine the use of enetrostomy in the management of these injuries. From the presented and statistically evaluated results, it can be concluded that Flint?s 3 grade classification can be used as the most reliable indicative and prognostic system. For the success of One stage surgical procedure, the most critical fact is differentiation between Flint?s Grade I and II (Chi Square 4.514; P) as well between Grade II and III. That means that by using One stage procedure, unfavourable results may be expected not only in Grade II, but as well in border cases between II and III. Also, according to the presented results, there were not differences observed in the success of management between Grade II and III (Chi Square 0.678; P0.05). That means that using Two stage procedure, unfavorable results can be prevented not only in the borderline cases between Grades II and III, but also in the Grade III. Two stage surgical approach in the repair of injured colon remains valuable and useful surgical procedure, even in spite of success of surgical technology and operative technique, in cases with severe and multiple abdominal injuries, and in borderline decision making. These procedures are also inevitable in the management of any complication of primary repair of the colonic wound. Using rational evaluation and good surgical technique, primary repair of can be used in almost 50% of civilian and war injuries of colon.