Injury to colon, a patient comes after 12 hours, next step to be done is:
|A||Resection of proximal colon and colostomy|
|C||Wait and watch|
|D||Resection of injured colon and proximal end is brought out as colostomy and distal end as mucous fistula|
a. There are three conceptually different methods for treating colonic injuries: primary repair, colostomy, and exteriorized repair.
b. Primary repairs include lateral suture of perforations and resection of the damaged colon with reconstruction by ileocolostomy or colocolostomy.
c. The advantage of primary repairs is that definitive treatment is carried out at the initial operation.
d. The disadvantage is that suture lines are created in suboptimal conditions and leakage may occur. Several different styles of colostomies have been used to manage colonic injuries.
e. The injured area can be resected and an end colostomy or ileostomy performed, and the distal colon can be brought to the abdominal wall as a mucous fistula or oversewn and left in the abdominal cavity.
f. Finally, a loop colostomy can be created proximal to a suture line, which is left in the abdominal cavity.
g. The advantage of colostomy is avoiding an unprotected suture line in the abdomen.
h. The disadvantage is that a second operation is required to close the colostomy. Often overlooked disadvantages are the complications associated with the creation of a colostomy, some of which may be fatal.
i. Exteriorized repairs are created by suspending a repaired perforation or anastomosis on the abdominal wall with an appliance after the fashion of a loop colostomy.
j. If after 10 days the suture line does not leak, it can be returned to the abdominal cavity under local anesthesia without subsequent risk of leakage. If the repair breaks down before 10 days, it is treated as a loop colostomy.
k. Stomal complications similar to those of colostomies also can occur with the exteriorization.