To Divert or Not?
- 2-3% leak rate with primary repair
- although low leak rate consider whether patient "can take a joke?"
Rectum:
- Pendulum has swung from primarily diverting to observational management more popular now
- A situation where observation might be dangerous is with a massive open pelvic # where diversion can prevent pelvic sepsis/osteomyelitis
Diversion:
- EEM uses loop ileostomy as his primary diversion technique (without on-table lavage)
- sigmoid end colostomy might be done if there is destructive injury to sigmoid where simpler just to take out sigmoid as colostomy
- don't just do a small local exicision: especially in watershed areas
- need to resect from one named vessel to the next! (ie; R hemi/L hemi)tra
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