Colon injury ranks second to small intestine injury in terms of incidence. However, due to the low liquid content and high bacterial load of colonic contents, peritonitis tends to appear later but is more severe. Injuries to the retroperitoneal colon may be underdiagnosed, often resulting in serious retroperitoneal infections.
Treatment of colon injury differs from that of small intestine injury because of factors such as the thinness of the colon wall, poor blood supply, and high bacterial content. In general, primary repair or primary resection and anastomosis (especially for right-sided colon injuries) are only considered in cases involving small tears, minimal abdominal contamination, and patients in good overall condition. For most patients, however, procedures such as colostomy or exteriorization of the bowel are initially performed, with closure of the stoma typically carried out 3–4 weeks later after the patient’s condition has improved. In cases involving more severe injuries, proximal colostomy may be performed following primary repair to prevent further contamination of the distal colon by its contents.
Primary repair is contraindicated under certain conditions, including:
- Severe abdominal contamination.
- Major multiple injuries or concurrent trauma to other abdominal organs requiring prompt surgical completion.
- Advanced age, poor overall condition, or comorbidities such as liver cirrhosis or diabetes.
- Hemorrhagic shock requiring massive blood transfusion (>2,000 ml), high-velocity firearm injuries, or delayed surgical intervention.