The diagnosis of trauma to the colon and rectum is usually found at the time of surgery. A rectal examination can show blood in the stool, which could indicate a colon injury. Thickening of the wall of the colon can identify a colon injury in a CT scan. Nondestructive colon injuries are those that involve less than half of the bowel wall and have not lost their circulation.
These types of injuries can be treated by primarily closing the colon wall without having to resort to a colostomy, in which the colon is brought to a hole on the outside of the abdomen.
There is, in fact, a higher rate of complications if a colostomy is performed on an injured colon. Destructive colon trauma includes those in which there is a loss of some of the colon as part of the injury.
More than half of the colon wall has been injured, or the blood supply to the colon has been compromised. Their injuries were traditionally treated with a colostomy because of the high risk of a blood infection following these types of injuries. Some research studies, however, have shown that primary repair of these injuries is possible without an increase in complications. The incidence of abdominal complications after colon injuries is highβup to 20 percent or more developing a blood infection.
Those patients who had to receive many blood transfusions in the first 24 hours after the injury had more complications than those who needed fewer transfusions less than 6 units of blood. Severe leakage of stool is a risk factor for getting sepsis and complications of colon injury. Delays in surgery from the time of trauma seem to increase the risk of complications. Retained foreign bodies, like bullets, caused an increase in complications but it was discovered that removing these foreign bodies did not change the outcome of the difficulty.
