Suture Line Failure in Intra-Abdominal Colonic Trauma: Is There An Effect of Segmental Variations in Blood Supply on Outcome?

摘要

Beginning with the landmark trial by Stone and Fabian,1 the ever-diminishing role of diversion for penetrating intra-abdominal colonic trauma has been the focus of much debate. Following this randomized trial that was published in 1979, multiple prospective,2"11 and many retrospective, studies have failed to show a benefit for diversion in decreasing the overall rate of infectious morbidity or reducing mortality after colonic injury.Indeed, in most centers, routine use of primary repair (PR) and resection with anastomosis (RA) after colonic injury has become well established. A few authors, however, have preached caution for patients with destructive injuries requiring resection,12 patients who require multiple transfusions,13 or patients who have medical co-morbidities.13 It may be that the risk of suture line failure (SLF), a very morbid and often fatal complication, is greater in these patient populations. In fact, much of the recent literature on colonic trauma has focused on identifying the few "high-risk" patients that may benefit from diversion. Unfortunately, while several risk factors have been determined, this "high-risk" population is not yet perfectly defined.