Colon Trauma

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 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

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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 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

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