In a 12 years old boy with gunshot wound to left colon. Management of choice is:
|A||Resection with proximal end colostomy and distal end mucosal loop|
|C||Open the abdomen and place a swab|
|D||Give lots of I.V. fluids|
a. Primary repair can be selected when known associated complicating factors have been excluded.
b. General criteria for primary repair include early diagnosis (within 4-6 hours), absence of prolonged shock or hypotension, absence of gross contamination of the peritoneal cavity, absence of associated colonic vascular injury, less than 6 units of blood transfused, and no requirement for the use of mesh to permanently close the abdominal wall.
c. Increased complication rates after primary repair are due to prolonged hypotension, massive intraperitoneal hemorrhage, more than two associated organs injured, significant fecal spillage, or delayed diagnosis.
d. Most patients with low-risk penetrating colonic injuries can be treated by primary closure or resection and primary anastomosis by following these guidelines.
e. High-risk colon injuries or those associated with severe injuries will benefit from resection and colostomy.
f. Exteriorization of the colonic repair has been performed infrequently because of extremely high rates of failure, repair breakdown, and infectious complications.