Colon Trauma
To view the entire topic, please log in or purchase a subscription.
Emergency Central is a collection of disease, drug, and test information including 5-Minute Emergency Medicine Consult, Davis’s Drug, McGraw-Hill Medical’s Diagnosaurus®, Pocket Guide to Diagnostic Tests, and MEDLINE Journals created for emergency medicine professionals. Explore these free sample topics:
-- The first section of this topic is shown below --
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 extravasated intraluminal flora
- Ascending and descending colon segments are retroperitoneal
- Morbidity and mortality increase if the diagnosis of colon injury is delayed
Etiology
- 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
-- To view the remaining sections of this topic, please log in or purchase a subscription --
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 extravasated intraluminal flora
- Ascending and descending colon segments are retroperitoneal
- Morbidity and mortality increase if the diagnosis of colon injury is delayed
Etiology
- 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
There's more to see -- the rest of this topic is available only to subscribers.