Prospective audit of multiple penetrating injuries to the colon: further support for primary closure.

Solitary colon injuries are being increasingly managed by intraperitoneal primary closure. The optimal management of the colon wound in multiple injuries of the colon, which have a high mortality, has not been determined. From 1983-1989, 668 patients sustained colonic injuries. In 71 of these patients the colon was injured at more than one site. Of the 597 single injuries to the colon, 472 (79%) were due to stabs and 102 (17%) to gunshot wounds. Sixty-eight men and three women sustained injuries at more than one site in the large intestine. The median age of patients was 26 years (range 13-66). In 61 patients the colon was injured at two sites and in seven patients at three sites. Three patients had more than three sites injured. The injuries were inflicted by: gunshots 35 (49%); stabs, 30 (42%); shotguns, three; and blunt trauma, three. Forty-one patients were treated by intraperitoneal primary closure (IPC) and 30 by a colostomy procedure or exteriorization of the primarily sutured colon (EPSC). Penetrating Abdominal Trauma Index (PATI) scores were high at 32 +/- 6, and were similar for all methods of colon wound management. Twenty-four patients were suffering from shock on admission, 13 of those patients were treated by primary repair and 11 were treated by an exteriorization procedure. Individuals treated by an exteriorization procedure stayed in hospital significantly longer, 45 days versus 21 days (P < 0.004) and had a higher mortality rate, five deaths versus one death (P < 0.04) than those patients who were primarily repaired. Intraperitoneal primary closure of all wounds is the method of choice for the majority of multiple injuries. Colostomy procedures or EPSC contribute to morbidity and mortality.