Surgical Management of Colonic Trauma: a Thai Perspective and Outcomes

Abstract

The management of colonic injuries has evolved substantially from conservative care to surgical intervention, with progressive improvements in techniques and outcomes. Nevertheless, injury severity remains a significant challenge, particularly when concurrent trauma to other organs increases complication and mortality rates. The selection of surgical strategy, whether primary repair or diversion procedure, is contingent upon injury severity and patient-specific factors. This study aimed to characterize the epidemiological profile and clinical outcomes of traumatic colonic injuries in Thailand and to compare postoperative outcomes between damage control surgery (DCS) and non-DCS management approaches. This retrospective study analyzed 77 patients diagnosed with colonic injuries (ICD10th: S365, S3650, S3651) admitted to Pranangklao Hospital and Maharat Nakhon Ratchasima Hospital between October 1, 2020, and September 30, 2023. The majority of patients were male (77.9%), of working age, and younger compared to populations with firearm-related injuries. Motor vehicle accidents were the predominant cause (74.0%), resulting in blunt trauma (80.5%) more frequently than penetrating trauma (19.5%). The most commonly injured site was the transverse colon (33.8%). The distribution of colonic injury grades was as follows: grade 1 (59.7%), grade 2 (5.2%), grade 3 (10.4%), grade 4 (10.4%), and grade 5 (14.3%). The overall mortality rate was 20.8% (16/77; 95% CI: 12.4–31.5). Colonic-related complications occurred in 7.8% of patients (6/77; 95% CI: 3.6–15.8). Primary repair was the predominant surgical approach (92.2%, 71/77; 95% CI: 83.4–96.6), while diversion procedures were performed in 7.8% (6/77; 95% CI: 3.4–16.6). Among patients with grade 5 injuries, 81.8% (9/11) underwent primary repair. This study supports primary repair as the first-line treatment for colonic injuries, even in cases of severe destructive trauma (grade 5).