Morbidity of colostomy closure following colon trauma

Recent reports have suggested alternative procedures to temporary colostomy because of the high morbidity associated with its closure. The charts of 137 patients, who had colostomy closure following colostomies for trauma, were reviewed. Barium enema was helpful in the preoperative evaluation in selected patients. Early closure in uncomplicated cases was not associated with greater problems. Fourteen patients had postoperative complications for an overall morbidity of 10.2%. There were no deaths in the series. Colostomy closure in the trauma patient appears to be safer than in patients whose colostomy is constructed for nontraumatic reasons. Meticulous technique, including leaving the skin and subcutaneous tissue open, is essential. It is concluded that the principle of diverting or exteriorized colostomy in the trauma patient should not be abandoned because of the hazards of subsequent closure.