Primary repair of colorectal injuries in childhood.

A retrospective survey of 44 children with colorectal perforating injuries secondary to shrapnel and high velocity bullets is presented. Seven patients had the injury limited to the colon or rectum. All patients were operated upon within 7 hr from the their colonic wounds and 20 underwent a colostomy. Five of the patients repaired primarily had their injuries to the left side of the colon or rectum. None of the patients undergoing primary repair suffered from an anastomotic leak. The mortality rate after primary repair was 16.6% and after colostomy 10%. The mortality was significantly different in the group of patients who had additional injuries where a colostomy procedure was associated with a lower mortality rate (11% versus 21%). Shock on admission and during operation affected survival adversely in all patients. The average hospital stay of survivors was 24 days with "primary repair" and 36 days with "colostomy."