Role of Protective Stoma in Destructive Colon Injuries in Gunshot Victims and Predictors of Post-Operative Morbidity in a Developing Country

Abstract

Introduction: Primary repair is becoming a rapidly emerging method for destructive colon injury. There is paucity of data regarding protecting stoma.

Methods: Retrospective review of Adult patients with penetrating destructive colon injuries at Aga Khan University Hospital, Pakistan was carried out.

Results: There were a total of forty two patients. The (group A) comprised of patients who had resection with end colostomy formation. While, (Group B) underwent resection and anastomosis with a protective stoma.

Morbidity: Post-operative outcomes were compared in both groups. There was no significant statistical difference in postoperative morbidity (40% versus 26%, p-value 0.57). However, length of stay and time to stoma reversal were significantly different between both the groups. Uni-variate and regression analysis was done to find out determinants of post-operative morbidity. Logistic regression analysis was done to find the extent of association between determinants and post-operative morbidity. Significant association was seen between pH < 7.35, age > 45 years, > 4 packed cell transfusion within 24 hours, post-operative inotropes and occurrence of post-operative morbidity.

Conclusion: Based on our findings and literature review we conclude that Post-operative morbidity is independent of operative procedure i.e. resection with end stoma or resection and anastomosis with a protective stoma. In high risk patients where the surgeon is uncomfortable with primary repair, Resection and Anastomosis with protective stoma which has seldom been mentioned in trauma literature has acceptable morbidity and mortality with relatively less morbid and early reversal of stoma when compared to end stoma.

Keywords: Colorectal trauma; Protective stoma

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