Colon Trauma
Basics
Description
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
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
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Citation
Schaider, Jeffrey J., et al., editors. "Colon Trauma." 5-Minute Emergency Consult, 6th ed., Lippincott Williams & Wilkins, 2020. Emergency Central, emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307188/all/Colon_Trauma.
Colon Trauma. In: Schaider JJJ, Barkin RMR, Hayden SRS, et al, eds. 5-Minute Emergency Consult. Lippincott Williams & Wilkins; 2020. https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307188/all/Colon_Trauma. Accessed October 7, 2024.
Colon Trauma. (2020). In Schaider, J. J., Barkin, R. M., Hayden, S. R., Wolfe, R. E., Barkin, A. Z., Shayne, P., & Rosen, P. (Eds.), 5-Minute Emergency Consult (6th ed.). Lippincott Williams & Wilkins. https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307188/all/Colon_Trauma
Colon Trauma [Internet]. In: Schaider JJJ, Barkin RMR, Hayden SRS, Wolfe RER, Barkin AZA, Shayne PP, Rosen PP, editors. 5-Minute Emergency Consult. Lippincott Williams & Wilkins; 2020. [cited 2024 October 07]. Available from: https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307188/all/Colon_Trauma.
* Article titles in AMA citation format should be in sentence-case
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