Restoration of continuity following damage control surgery for penetrating colon injury - A South African experience

INTRODUCTION: The management of colonic injury following damage control surgery (DCS) remains controversial, particularly regarding whether delayed repair (delayed primary repair or anastomosis) or delayed diversion is the safer approach at the repeat laparotomy. This study evaluates the outcomes of these two strategies in penetrating colon injury patients requiring damage control surgery. METHODS: A retrospective review was conducted of patients sustaining penetrating colon injuries admitted to a South African tertiary trauma centre over 12 years (2012-2024) using an electronic trauma registry. Patients who underwent DCS and survived to planned second-look laparotomy were analysed. At relook, definitive management was categorised as either restoration of bowel continuity (primary suture repair or resection with anastomosis) or delayed diversion (end colostomy with or without mucus fistula). Data on demographics, admission physiology and Injury Severity Score were analysed, with leak rate, mortality and gastrointestinal complications as primary outcomes. RESULTS: A total of 653 patients sustained penetrating colonic injury and 132 (20%) required DCS. After exclusions, 96 patients were analysed (42 in the delayed repair group and 54 in the delayed diversion group). The delayed repair group had a 24% leak rate. In the delayed diversion group, 9% of patients experienced colon-related complications. Colon-related morbidity associated with delayed repair was significantly higher than with delayed diversion. CONCLUSIONS: Restoration of bowel continuity for penetrating colon injuries at repeat laparotomy following DCS is associated with a high rate of anastomotic leak or suture-line failure. Extreme caution is advised when considering delayed repair in this setting.