The colon or large intestine is the final organ responsible for nutrient and fluid absorption before digestive material exits the body as waste. Large quantities of bacteria in the colon aid in digestion of certain materials but make injury to the organ extremely dangerous. When injury occurs, bacteria-laden colonic contents are released into the usually sterile abdominal space, which can result in systemic infection and often requires resection of the injured part of the colon. Injury can occur during any procedure performed in the abdominal cavity, in addition to less-invasive scope procedures, such as a colonoscopy. Depending on the operation, injuries are slightly more common in laparoscopic procedures; however, this increase is diminished when the surgeon is specifically trained and regularly performs these operations. These complications have devastating results and, fortunately, are rare.
Infection and Abscess
Depending on the size and extent of the injury, colonic contents released through the perforation are either contained in a specific area, resulting in an abscess, or spread throughout the abdomen, causing systemic infection. Systemic infection develops rapidly after the injury, and the patient can quickly become septic, requiring an admission to the intensive care unit. If the infection is localized and forms an abscess, it must be drained surgically, either in the operating room or by a catheter inserted by an interventional radiologist.
Colonic Diversion and Colostomy Requirement
Weighing the risk of further infection against immediately repairing the colon at the time of injury is a complex decision made by the colo-rectal surgeon called to help with the repair. Because digested food carries large quantities of bacteria through the colon, contents are often diverted away from the injury site and out of the body via a colostomy. A colostomy is created by dividing the colon and attaching the end that receives digested food from the small intestine to an incision made in the abdomen. This allows the injured area or site of resection to heal with decreased risk of infection, as it is not responsible for carrying digested food. Once the injured area is healed, the patient undergoes a second operation to reconnect the end of the colon that formed the colostomy with the end connected to the anus. This restores normal gastrointestinal continuity and allows the patient to have normal bowel movements.
Colon Resection
If the surgeon feels that the injury would not heal well if repaired, the decision is made to remove the injured section of colon and rejoin the two healthy ends together with a stapling device. If a resection is required, digestive contents are often diverted through the abdomen by means of a colostomy. There are no long-term effects after partial-colon resection, as the remaining bowel is sufficient to perform digestive requirements.
References
- "Complications in Surgery and Trauma"; Stephen M. Cohn; 2007
- Colon and Rectal Clinic of Ft. Lauderdale: Risks and Complications of Surgery
- Surgical Treatment: Colon Injuries
