Presentation Information
[INTS3-1]Laparoscopic Colectomy for Traumatic Colon Injury: A Case Series of Minimally Invasive Management
*Hyunseok Jang1, Younggoun Jo1, Yunchul Park1, Euisung Jeong1, Jungchul Kim1, Dowan Kim2 (1. Division of Trauma, Department of Surgery, Chonnam National University Medical School and Hospital, Republic of Korea, 2. Department of Thoracic and Cardiovascular Surgery, Chonnam National University Hospital, Chonnam National University Medical School)
Background: The therapeutic role of laparoscopy in trauma is continuously expanding. While typically reserved for strictly stable patients, we present a case series of four patients with right-sided colonic or mesocolic injuries and borderline hemodynamics, demonstrating the feasibility and safety of minimally invasive management.
Case Presentation: The series includes four patients with varying mechanisms of injury who exhibited signs of potential instability, such as persistent tachycardia and decreasing hemoglobin levels. Three patients successfully underwent a laparoscopic right hemicolectomy: one with a stab wound resulting in right colon perforation, one with blunt trauma leading to diffuse right colon ischemia, and one presenting with active bleeding. The fourth patient sustained a stab wound with active contrast extravasation from a right mesocolic vessel injury, which was effectively managed with laparoscopic exploration and hemostasis. When extensive contamination or active bleeding was encountered, strategic adjuncts such as a mini-laparotomy or utilizing the stab wound as a functional port were employed. This facilitated massive irrigation and secure hemostasis while preserving minimal invasiveness.
Clinical Outcomes: All procedures were completed successfully without the need for conversion to a formal laparotomy. Effective hemostasis and complete contamination control were achieved in all cases. The patients benefited from reduced wound sizes and expedited postoperative recovery despite their initial borderline hemodynamic status.
Conclusion: Laparoscopic right hemicolectomy and mesocolic vessel repair are safe and definitive management strategies for selected right-sided colon trauma. Employing adjuncts like mini-laparotomy enables adequate irrigation and safe surgery, proving that minimally invasive approaches remain highly effective even in patients with borderline hemodynamics, active bleeding, or peritonitis.
Case Presentation: The series includes four patients with varying mechanisms of injury who exhibited signs of potential instability, such as persistent tachycardia and decreasing hemoglobin levels. Three patients successfully underwent a laparoscopic right hemicolectomy: one with a stab wound resulting in right colon perforation, one with blunt trauma leading to diffuse right colon ischemia, and one presenting with active bleeding. The fourth patient sustained a stab wound with active contrast extravasation from a right mesocolic vessel injury, which was effectively managed with laparoscopic exploration and hemostasis. When extensive contamination or active bleeding was encountered, strategic adjuncts such as a mini-laparotomy or utilizing the stab wound as a functional port were employed. This facilitated massive irrigation and secure hemostasis while preserving minimal invasiveness.
Clinical Outcomes: All procedures were completed successfully without the need for conversion to a formal laparotomy. Effective hemostasis and complete contamination control were achieved in all cases. The patients benefited from reduced wound sizes and expedited postoperative recovery despite their initial borderline hemodynamic status.
Conclusion: Laparoscopic right hemicolectomy and mesocolic vessel repair are safe and definitive management strategies for selected right-sided colon trauma. Employing adjuncts like mini-laparotomy enables adequate irrigation and safe surgery, proving that minimally invasive approaches remain highly effective even in patients with borderline hemodynamics, active bleeding, or peritonitis.