Management and Outcomes of Traumatic Colon Injury in Civilian and Military Patients

• Published in: The American surgeon 2011-12, Vol.77 (12), p.1685-1691
• Main Authors: SAMBASIVAN, Chitra N, UNDERWOOD, Samantha J, KUEHN, Reed B, CHO, S. D, KIRALY, Laszlo N, HAMILTON, Gregory J, FLAHERTY, Stephen F, DORLAC, Warren C, SCHREIBER, Martin A
• Format: Article
• Language: English
• Subjects: Abdominal Injuries - diagnosis; Abdominal Injuries - mortality; Abdominal Injuries - surgery; Adult; Anastomosis, Surgical; Biological and medical sciences; Casualties; Clinical trials; Colectomy - methods; Colon - injuries; Colon - surgery; Colostomy - methods; Female; Follow-Up Studies; General aspects; Hernias; Hospitals; Humans; Injuries; Injuries of the abdomen. Foreign bodies of the digestive system; Ischemia; Male; Medical sciences; Middle Aged; Military Personnel; Mortality; Ostomy; Respiratory distress syndrome; Retrospective Studies; Standard deviation; Survival Rate - trends; Trauma Severity Indices; Traumas. Diseases due to physical agents; Treatment Outcome; United States - epidemiology; Young Adult
• ISSN: 0003-1348; 1555-9823
• DOI: 10.1177/000313481107701244

Divergent injury patterns may indicate the need for differing strategies in combat and civilian trauma patients. This study aims to compare outcomes of colon injury management in these two populations. Parallel retrospective reviews were conducted comparing warfighters (n = 59) injured downrange and subsequently transferred to the United States with civilians (n = 30) treated at a United States Level I trauma center. Patient characteristics, mechanisms of injury, treatment course, and complications were compared. The civilian (CP) and military (MP) populations did not differ in Injury Severity Score (MP 20 vs CP 26; P = 0.41). The MP experienced primarily blast injuries (51%) as opposed to blunt trauma (70%; P < 0.01) in the CP. The site of colon injury did not differ between groups (P = 0.15). Initial management was via primary repair (53%) and resection and anastomosis (27%) in the CP versus colostomy creation (47%) and stapled ends (32%) in the MP (P < 0.001). Ultimately, the CP and MP experienced equivalent continuity rates (90%). Overall complications (MP 68% vs CP 53%; P = 0.18) and mortality (MP 3% vs CP 3%; P = 0.99) did not differ between the two groups. The CP and MP experience different mechanisms and initial management of colon injury. Ultimately, continuity is restored in the majority of both populations.