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?

**Core Concept**
The management of a gunshot wound to the transverse colon with extensive tissue destruction and fecal contamination involves a multidisciplinary approach to prevent complications such as peritonitis, sepsis, and colonic stricture. The primary goal is to control the infection, restore bowel continuity, and manage potential nutritional deficiencies.

**Why the Correct Answer is Right**
In this scenario, the patient is at high risk for developing peritonitis and sepsis due to the contaminated wound. A primary closure of the colon would lead to a high risk of leakage, which would exacerbate the infection. A Hartmann's procedure, which involves resecting the injured segment of the colon, creating a colostomy, and closing the remaining colon, is a more appropriate management strategy. This approach allows for the control of the infection, restoration of bowel continuity at a later date, and management of potential nutritional deficiencies.

**Why Each Wrong Option is Incorrect**

* **Option A:** Primary closure of the colon is not recommended in this scenario due to the high risk of leakage and subsequent infection.
* **Option B:** Total parenteral nutrition may be required to manage potential nutritional deficiencies, but it is not a primary management strategy for this injury.
* **Option D:** Resection of the entire colon is not necessary in this scenario, and a Hartmann's procedure is a more appropriate management strategy.

**Clinical Pearl / High-Yield Fact**
In cases of gunshot wounds to the gastrointestinal tract, a multidisciplinary approach involving surgery, infectious disease, and nutrition teams is essential to prevent complications and ensure optimal outcomes.

**Correct Answer:** C. Hartmann's procedure.

✓ Correct Answer: B. Resection with proximal colostomy and distal mucous fistula