An aggressive approach to penetrating adominal trauma will detect the majority of intestinal injuries. A high index of suspicion in patients with abdominal trauma, combined with diagnostic peritoneal lavage or contrast studies, can indicate the diagnosis, but if in doubt it is better to operate as early as possible. Most blunt and penetrating injuries of the intestines can be managed by debridement and simple closure, although devastating transection or devascularization of the hollow organs requires resection. In cases of penetrating colonic injuries, the trend is towards safe primary repair. Full-thickness penetrating colonic injuries without severe tissue loss, devascularization, or heavy contamination in low-risk patients with a high trauma score, low penetrating abdominal trauma index, and few associated intra-abdominal injuries can usually be treated by primary closure. Otherwise, it may be best to perform a diverting colostomy.
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