Colon Trauma

Basics

Trauma that perforates the colon inflames the cavity in which it lies
Peritoneal inflammation from hollow viscus perforation often requires hours to develop
Mesenteric tears from blunt trauma cause hemorrhage and bowel ischemia
Delayed perforation from ischemic or necrotic bowel may occur
Peritonitis and sepsis may develop from extravasated intraluminal flora
Ascending and descending colon segments are retroperitoneal
Morbidity and mortality increase if the diagnosis of colon injury is delayed

Penetrating abdominal trauma:
- The colon is the second most commonly injured organ in penetrating trauma
- A colon injury is involved in about a third of trauma cases undergoing laparotomy for gunshot wounds with the transverse colon being the segment most commonly injured
Blunt abdominal trauma:
- Colon injury in blunt trauma is rare and difficult to diagnose
- Hollow-viscus injuries in blunt trauma typically occur in setting of high energy transfer and are accompanied by other injuries
- Burst injury occurs from compression of a closed loop of bowel
- Intestine may be squeezed between a blunt object (lap belt) and vertebral column or bony pelvis
- Sudden deceleration may produce bowel–mesenteric disruption and consequent devascularization
- With deceleration, the sigmoid and transverse colon are most vulnerable
Transanal injury:
- Iatrogenic endoscopic or barium enema injury
- Foreign bodies used during sexual activities may reach and injure the colon
- Compressed air under high pressure such as at automobile repair facilities can perforate the colon even if the compressor nozzle is not fully inserted anally
- Swallowed sharp foreign bodies (toothpick) may penetrate the colon, particularly the cecum, appendix, and sigmoid:
  - Most foreign bodies pass without complications

Pediatric Considerations
Unlike adults, children have an equal frequency of blunt and penetrating colon injuries

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