Guidelines for the management of Colon & Rectal Trauma

Haemorrhagic Shock.
Hypothermia - Coagulopathy - Acidosis
Damage Control Procedure
Control Haemorrhage
Rapid primary suture of small wounds.
Transect & close (stapler) more extensive injuries for later repair.
Avoid colostomy.

Colon & Rectum

Introduction
Diagnosis
Management - History
Management - Colon
Management - Rectum
Management - Guidelines
References

Colon:
Primary repair.
Consider colostomy if >24 hours post trauma.

Rectum:

Primary Repair if:
Intra-peritoneal rectal injury.
Extra-peritoneal rectal injury that can be mobilised intra-peritoneally or repaired trans-anally.
No pre-sacral drainage
No distal washout.

Proximal diverting loop colostomy if:
More extensive rectal injury.
Position makes repair impossible.
Pre-sacral drainage if high-energy, blunt trauma or delayed surgery
No distal washout.

Hartmann's Procedure if:
Severe extra-peritoneal rectal injury.

References