The role of
colostomy in the treatment of abdominal
trauma has changed over the past several decades. Primarily as a result of its successful use in military settings,
colostomy initially was the mainstay of treatment for penetrating injury to the colon, rectal injury, and some forms of blunt
trauma. Subsequent civilian experience with the techniques of primary repair of penetrating colon injury resulted in a decrease in the number of
colostomies performed. Coupled with this experience, early data on adverse outcome from
colostomy closure tended to support the trend of the ever-diminishing place of
colostomy for
trauma.
Colostomy has always been used for two purposes in
trauma care: prevention or arrest of fecal contamination of the peritoneal cavity and diversion of the fecal stream. Despite the decreased need for
colostomy in some forms of penetrating colon injury, there are several conditions that still utilize
colostomy to accomplish one or both of these purposes. Indications for
colostomy can now be regarded as absolute or relative depending upon the need for diversion or the requirement to prevent contamination. There are relatively few
contraindications to
colostomy use. Present results of
colostomy closure do not represent excessive risk to the patient and should not impact negatively on the decision to perform a
colostomy for
trauma.