<prompt> 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?Debridement and closure of wound with a proximal colostomyResection with proximal colostomy and distal mucous fistulaResection of the injured colon with primary anastomosis and proximal colostomyResection of the wound with primary anastomosis and proximal cecostomy  <response>: 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. 