대한대장항문학회

This report represents a clinical study on the experience with 32 cases of colorectal<br>injury which had been admitted and treated with surgical intervention at the Department<br>of Surgery, Korea University Guro Hospital from January 1983 to December 1992. The<br>results were as follows: The age of the patients ranged from 15 to 76 years old, with<br>56.3% occurring between 11 and 40 years old, and the sex ratio between male and<br>female was 5.4：1. The mechanisms of trauma were penetrating injuries(34.4%), blunt<br>injuries(34.4%) and others(mainly iatrogenic injuries). The 19 cases(59.3%) were<br>associated with other organ injuries. Among them, the most frequent associated organ<br>was small bowel. The common site of injuries was transverse colon(25%) and sigmoid<br>colon(25%), followed by right colon and anorectum. In operative procedure,<br>22<br>patients(68.7%) were treated by primary repair without proximal colostomy and 8<br>patients(25% ) were treated by primary closure or resection and anastomosis with<br>proximal colostomy. The remaining 2 patients(6.3%) were managed by exteriorization<br>with primary closure. To estimate the degree of injuries, Flint's classification and Injury<br>Severity Score(ISS) was used. The most of complications and mortalities occured in<br>Flint GradeⅢ and ISS above 20. Postoperative complications revealed in 7<br>patients(21.9%), the incidence of complications according to the operative procedure was<br>62.5% with colostomy, 9.1% without colostomy, and the incidence of complications<br>according to the delayed time to operation was 66.7% over 24 hours, 12.5% until 6<br>hours. Wound infection was 5 cases(27.7%), fecal fistula and sepsis and renal failure<br>were 3 cases(16.7%) respectively.<br>In conclusion, early detection of colorectal injury, proper grading and<br>adequate<br>operative procedure are important to reduce the postoperative complications and<br>mortalities in patients with colorectal injuries.<br>