Exxcellence pearls: large bowel injuries

Question 0

When can primary closure of the large bowel injury be considered?

Answer 0

If the edges are free of crushed tissue or thermal injury and the extent of the injuries less than half the circumference of the bowel.

Question 1

What principles should be considered regarding suture orientation and lumen size?

Answer 1

The bowel should be repaired to produce the widest possible lumen and be free of tension.

Question 2

What is needed if undue tension cannot be relieved or a watertight closure is not possible?

Answer 2

Diverting colostomy

Question 3

How should a large bowel defect be closed?

Answer 3

3-0 Vicryl running watertight suture on mucosa. 3-0 silk interrupted sutures to invert first layer.

Question 4

How should patients be managed postoperatively after a large bowel injury?

Answer 4

Low residue diet with slow advancement. Consider broad-spectrum antibiotic if none was given preoperatively. NG tube is not recommended.