Carrillo E H, Somberg L B, Ceballos C E, Martini M A, Ginzburg E, Sosa J L, Martin L C
Department of Surgery, School of Medicine, University of Miami FL, USA.
J Am Coll Surg. 1996 Dec;183(6):548-52.
Experience in the treatment of patients with blunt colonic injuries is based on isolated case reports, and it is unclear whether the principles that guide the management of penetrating colonic injuries should be applied to these patients. Reviews of patients with these injuries suggest that such injuries present unique problems for diagnosis and treatment and are accompanied by excessive morbidity and mortality.
A 42-month retrospective case series was analyzed.
Data from 27 patients were analyzed, accounting for 8.5 percent of all colon and rectal injuries and for 0.5 percent of total blunt trauma admissions. Automobile crashes were the cause of injuries in 20 patients (74 percent). The mean Injury Severity Score was 28. All but 2 patients were operated on within 3 hours after admission. No significant difference was found in the morbidity and mortality rates based on the operation performed to manage the colonic injury. Indications for early exploration included a positive diagnostic peritoneal lavage in 23 patients, abnormal radiologic findings in 2, and positive clinical abdominal findings in the remaining 2 patients.
Blunt colonic and rectal injuries are uncommon and pose problems for diagnosis and treatment. Associated injuries are common, and steering wheel compression of the upper abdomen as well as lap belts seem to predispose to colonic injuries. Initial diagnosis is made at the time of operation, and a thorough exploration of the abdominal cavity is important to diagnose associated injuries. Treatment must be individualized; however, based on our observations, the creation of ostomies is not mandatory for the treatment of these injuries.
钝性结肠损伤患者的治疗经验基于个别病例报告，尚不清楚指导穿透性结肠损伤处理的原则是否应应用于这些患者。对这些损伤患者的综述表明，此类损伤在诊断和治疗方面存在独特问题，并伴有过高的发病率和死亡率。
分析了一个为期42个月的回顾性病例系列。
分析了27例患者的数据，占所有结肠和直肠损伤的8.5%，占钝性创伤入院总数的0.5%。20例患者（74%）的损伤原因是汽车碰撞。平均损伤严重度评分是28分。除2例患者外，所有患者均在入院后3小时内接受了手术。根据处理结肠损伤所进行的手术，发病率和死亡率未发现显著差异。早期探查的指征包括23例患者诊断性腹腔灌洗阳性，2例患者影像学检查异常，其余2例患者腹部临床检查阳性。
钝性结肠和直肠损伤并不常见，在诊断和治疗方面存在问题。合并损伤很常见，上腹部方向盘挤压以及安全带似乎易导致结肠损伤。手术时做出初步诊断，对腹腔进行全面探查对于诊断合并损伤很重要。治疗必须个体化；然而，根据我们的观察，造口术并非治疗这些损伤的必要手段。
