COLOSTOMY VERSUS NON COLOSTOMY WITH PRIMARY REPAIR IN COLORECTAL EMERGENCIES

Mohamed L. Ahmed (MD), Asem F. Moustafa (MD) and Abd El-Gwad F. Baker (MBBCH)*

ABSTRACT

Objectives: To compare both techniques (colostomy versus non colostomy with primary repair in colorectal emergencies) as a modern operative management regarding post-operative complications and outcome to expand the possibility of primary repair of colonic injuries. Background: Colonic emergencies may be repaired with fecal diversion through cutaneous stoma. However primary repair without fecal diversion may be better suited for some types of colonic injuries. Methods: This study is a prospective, comparative, and descriptive study of 40 patients with colorectal emergencies. Patients were managed either by repair alone or repair with proximal diversion based on estimation of risk factors. Results: Using primary repair without colostomy for colorectal emergencies is associated with more incidences of fistulas and longer time to remove the drain. However there are no differences regarding post-operative infection, time to recovery and mortality. Conclusion: Primary repair is better suited for colon injuries of lower grades, mild or no fecal contamination, absence of shock or significant associated injuries Primary repair with proximal colostomy is better suited for destructive colon injuries, severe fecal contamination, presence of shock and significant associated injuries.

Keywords: Colorectal injury, colostomy, fistula, proximal diversion, repair.