A 19-year-old man is brought into the emergency department with a gunshot wound that occurred 4 hours before admission. At exploratory laparotomy, an injury is noted in the transverse colon with extensive tissue destruction. There is a large amount of fecal contamination. Management of this injury should include which of the following?
The necrotic bowel is resected, the proximal end is constructed as an end colostomy, and the distal end is constructed as a mucous fistula. This is the best procedure because it will avoid an anastomosis in a contaminated abdomen. Any procedure that involves either wound closure or anastomosis in an abdomen with extensive fecal contamination presents a significant risk of leakage and therefore should not be performed. Exteriorization should not be performed unless ischemic bowel is resected.
Debridement and closure of wound with a proximal colostomy
Resection with proximal colostomy and distal mucous fistula
Resection of the injured colon with primary anastomosis and proximal colostomy
Resection of the wound with primary anastomosis and proximal cecostomy
Trauma