Management of Small Bowel and Colorectal Injuries in Trauma

Management of Small Bowel and Colorectal Injuries in Trauma

Arda Isik¹, Federico Coccolini², Diego Mariani³

¹Istanbul Medeniyet University, Istanbul, Turkey
²Pisa University Hospital, Pisa, Italy
³ASST Ovest Milanese, Italy

Abstract:

Background:
Traumatic injuries to the small bowel and colon are associated with significant morbidity and require timely surgical intervention. The determination of management decisions is contingent upon the mechanism of injury, the anatomical site, the contamination level, and hemodynamic stability.

Discussion:
Small bowel injuries are typically managed with primary repair when less than 50% of the bowel circumference is involved and tissue viability is preserved. Segmental resection with primary anastomosis is the preferred surgical intervention in cases of devitalised bowel or multiple injuries. For colonic trauma, primary repair or resection with anastomosis is appropriate in stable patients with minimal contamination. In unstable patients or delayed presentations, resection with fecal diversion is often required. Management of rectal injuries is determined by location: intraperitoneal injuries are treated similarly to colon injuries, while extraperitoneal injuries often necessitate diversion, presacral drainage, and possibly distal rectal washout. Laparoscopy has been demonstrated to be a useful diagnostic and therapeutic tool in selected penetrating trauma cases. Postoperative complications may include sepsis, abscess, and anastomotic leak, values the importance of early recognition and tailored surgical intervention.

Conclusion:
The optimal management of small bowel and colorectal trauma is possible upon timely diagnosis, damage control when indicated, and individualised surgical strategy based on patient physiology and injury pattern. In selected cases, primary repair is a viable option; however, diversion remains imperative in scenarios where instability or contamination is present.

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