Colon Trauma is a topic covered in the 5-Minute Emergency Consult.

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Basics

Description

  • 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 the extravasated intraluminal flora.
  • Ascending and descending colon segments are retroperitoneal.
  • The left colon has a higher bacterial load than the right.
  • Morbidity and mortality increase if the diagnosis of colon injury is delayed.

Etiology

  • Penetrating abdominal trauma:
    • The colon is the 2nd most commonly injured organ in penetrating trauma.
    • Gunshot wounds have the highest incidence.
    • Transverse colon is most commonly injured.
    • Often presents with peritonitis
  • Blunt abdominal trauma:
    • Colon rarely injured in blunt trauma
    • 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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Citation

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TY - ELEC T1 - Colon Trauma ID - 307188 Y1 - 2016 PB - 5-Minute Emergency Consult UR - https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307188/all/Colon_Trauma ER -