Management of penetrating colon and rectal injuries in the pediatric patient

Elliott R. Haut, Michael L. Nance, Martin S. Keller, Jonathan I. Groner, Henri Ford, Ann Kuhn, Barbara Tuchfarber, Victor Garcia, C. William Schwab, Perry W. Stafford

Research output: Contribution to journalArticle

27 Citations (Scopus)

Abstract

PURPOSE: Management of civilian penetrating colon injuries in the adult has evolved from the universal use of fecal diversion to the highly selective use of colostomy. 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 the period of review, 53 children with a penetrating colorectal injury were identified. Firearms caused 89 percent of the injuries. The colon was injured in 83 percent (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 treated with colostomy. The hospital length of stay was longer in the colostomy group (17.6 days vs. 11.4 days). The complication rate was higher in the colostomy group (55 percent vs. 27 percent), which included two patients with stoma-related complications. There was no mortality in this series. CONCLUSIONS: Primary repair was used safely in most cases of civilian penetrating colon injuries in the pediatric population. All rectal injuries were treated with colostomy in this series. Fecal diversion was used selectively. Colostomy was performed for selected cases of colon wounds associated with shock, multiple blood transfusions, multiple other injuries, extensive contamination, and high-velocity weapons. In the absence of these associated factors, primary repair appears justified.

Original languageEnglish (US)
Pages (from-to)1526-1532
Number of pages7
JournalDiseases of the Colon and Rectum
Volume47
Issue number9
DOIs
StatePublished - Sep 1 2004
Externally publishedYes

Fingerprint

Colostomy
Colon
Pediatrics
Wounds and Injuries
Rectum
Length of Stay
Weapons
Multiple Trauma
Trauma Centers
Firearms
Blood Transfusion
Population
Shock
Mortality

Keywords

  • Colon injury
  • Colon trauma
  • Colostomy
  • Gunshot wound
  • Pediatric trauma
  • Penetrating trauma
  • Penetrating wounds
  • Primary repair
  • Rectal injury

ASJC Scopus subject areas

  • Gastroenterology

Cite this

Haut, E. R., Nance, M. L., Keller, M. S., Groner, J. I., Ford, H., Kuhn, A., ... Stafford, P. W. (2004). Management of penetrating colon and rectal injuries in the pediatric patient. Diseases of the Colon and Rectum, 47(9), 1526-1532. https://doi.org/10.1007/s10350-004-0605-0

Management of penetrating colon and rectal injuries in the pediatric patient. / Haut, Elliott R.; Nance, Michael L.; Keller, Martin S.; Groner, Jonathan I.; Ford, Henri; Kuhn, Ann; Tuchfarber, Barbara; Garcia, Victor; Schwab, C. William; Stafford, Perry W.

In: Diseases of the Colon and Rectum, Vol. 47, No. 9, 01.09.2004, p. 1526-1532.

Research output: Contribution to journalArticle

Haut, ER, Nance, ML, Keller, MS, Groner, JI, Ford, H, Kuhn, A, Tuchfarber, B, Garcia, V, Schwab, CW & Stafford, PW 2004, 'Management of penetrating colon and rectal injuries in the pediatric patient', Diseases of the Colon and Rectum, vol. 47, no. 9, pp. 1526-1532. https://doi.org/10.1007/s10350-004-0605-0
Haut, Elliott R. ; Nance, Michael L. ; Keller, Martin S. ; Groner, Jonathan I. ; Ford, Henri ; Kuhn, Ann ; Tuchfarber, Barbara ; Garcia, Victor ; Schwab, C. William ; Stafford, Perry W. / Management of penetrating colon and rectal injuries in the pediatric patient. In: Diseases of the Colon and Rectum. 2004 ; Vol. 47, No. 9. pp. 1526-1532.
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AU - Nance, Michael L.

AU - Keller, Martin S.

AU - Groner, Jonathan I.

AU - Ford, Henri

AU - Kuhn, Ann

AU - Tuchfarber, Barbara

AU - Garcia, Victor

AU - Schwab, C. William

AU - Stafford, Perry W.

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N2 - PURPOSE: Management of civilian penetrating colon injuries in the adult has evolved from the universal use of fecal diversion to the highly selective use of colostomy. 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 the period of review, 53 children with a penetrating colorectal injury were identified. Firearms caused 89 percent of the injuries. The colon was injured in 83 percent (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 treated with colostomy. The hospital length of stay was longer in the colostomy group (17.6 days vs. 11.4 days). The complication rate was higher in the colostomy group (55 percent vs. 27 percent), which included two patients with stoma-related complications. There was no mortality in this series. CONCLUSIONS: Primary repair was used safely in most cases of civilian penetrating colon injuries in the pediatric population. All rectal injuries were treated with colostomy in this series. Fecal diversion was used selectively. Colostomy was performed for selected cases of colon wounds associated with shock, multiple blood transfusions, multiple other injuries, extensive contamination, and high-velocity weapons. In the absence of these associated factors, primary repair appears justified.

AB - PURPOSE: Management of civilian penetrating colon injuries in the adult has evolved from the universal use of fecal diversion to the highly selective use of colostomy. 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 the period of review, 53 children with a penetrating colorectal injury were identified. Firearms caused 89 percent of the injuries. The colon was injured in 83 percent (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 treated with colostomy. The hospital length of stay was longer in the colostomy group (17.6 days vs. 11.4 days). The complication rate was higher in the colostomy group (55 percent vs. 27 percent), which included two patients with stoma-related complications. There was no mortality in this series. CONCLUSIONS: Primary repair was used safely in most cases of civilian penetrating colon injuries in the pediatric population. All rectal injuries were treated with colostomy in this series. Fecal diversion was used selectively. Colostomy was performed for selected cases of colon wounds associated with shock, multiple blood transfusions, multiple other injuries, extensive contamination, and high-velocity weapons. In the absence of these associated factors, primary repair appears justified.

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