PURPOSE: Management of civilian penetrating colon injuries in the adult has ev olved from the universal use of fecal diversion to the highly selective use of c olostomy. We hypothesized that a similar management appro...PURPOSE: Management of civilian penetrating colon injuries in the adult has ev olved from the universal use of fecal diversion to the highly selective use of c olostomy. We hypothesized that a similar management approach was appropriate for the pediatric population. METHODS: A retrospective review of pediatric patients (age <17 years) with a penetrating colorectal injury was performed at six Level I trauma centers for the period January 1990 through June 2001. RESULTS: For th e period of review, 53 children with a penetrating colorectal injury were identi fied. Firearms caused 89 percent of the injuries. The colon was injured in 83 pe rcent (n = 44) of patients and the rectum in 17 percent (n = 9) of patients. The colorectal injury was managed without colostomy in 62 percent (n = 33) and with colostomy in 38 percent (colon = 11, rectum = 9). All rectal injuries were trea ted with colostomy. The hospital length of stay was longer in the colostomy grou p (17.6 days vs. 11.4 days). The complication rate was higher in the colostomy g roup (55 percent vs. 27 percent), which included two patients with stoma-relate d complications. There was no mortality in this series. CONCLUSIONS: Primary rep air was used safely in most cases of civilian penetrating colon injuries in the pediatric population. All rectal injuries were treated with colostomy in this se ries. Fecal diversion was used selectively. Colostomy was performed for selected cases of colon wounds associated with shock,multiple blood transfusions,multipl e other injuries, extensive contamination, and high-velocity weapons. In the ab sence of these associated factors, primary repair appears justified.展开更多
文摘PURPOSE: Management of civilian penetrating colon injuries in the adult has ev olved from the universal use of fecal diversion to the highly selective use of c olostomy. We hypothesized that a similar management approach was appropriate for the pediatric population. METHODS: A retrospective review of pediatric patients (age <17 years) with a penetrating colorectal injury was performed at six Level I trauma centers for the period January 1990 through June 2001. RESULTS: For th e period of review, 53 children with a penetrating colorectal injury were identi fied. Firearms caused 89 percent of the injuries. The colon was injured in 83 pe rcent (n = 44) of patients and the rectum in 17 percent (n = 9) of patients. The colorectal injury was managed without colostomy in 62 percent (n = 33) and with colostomy in 38 percent (colon = 11, rectum = 9). All rectal injuries were trea ted with colostomy. The hospital length of stay was longer in the colostomy grou p (17.6 days vs. 11.4 days). The complication rate was higher in the colostomy g roup (55 percent vs. 27 percent), which included two patients with stoma-relate d complications. There was no mortality in this series. CONCLUSIONS: Primary rep air was used safely in most cases of civilian penetrating colon injuries in the pediatric population. All rectal injuries were treated with colostomy in this se ries. Fecal diversion was used selectively. Colostomy was performed for selected cases of colon wounds associated with shock,multiple blood transfusions,multipl e other injuries, extensive contamination, and high-velocity weapons. In the ab sence of these associated factors, primary repair appears justified.
