Penetrating combat injuries of the colorectal region

Abstract

Colorectal war injuries can be treated with primary repair or by colostomy. We report our experience with both treatments. During the Croatian war from July 1991 to March 1994, 155 patients with colorectal injuries were treated at the Surgical Clinic, University Hospital Split. This group represents 7% of all patients (n = 2220) with gunshot and shrapnel wounds treated in this period at our clinic. The median patient age was 24.7 years (range 14-70 years). The majority of the patients (96.7%) were male. Concomitant injuries of the colon (83.7%) and rectum (69%) were found more frequently than isolated ones. 50 patients were operated on as emergencies in our clinic, while 105 were operated on in field hospitals. In 28 patients primary repair of the colorectal injury was performed (without derivation), whereas 127 patients were treated by colostomy. In those patients 106 wounds were closed electively during a second operation. The average in hospital stay was 32.3 days (range 10-65 days). Using PATI and FCIS scores for colorectal injuries, 80% of our patients had life-threatening injuries. In the cases with primary repair the percentage of complications was high (92%). In the cases with the diverting colostomy it was only 34%. The high complication rate in the cases with primary repair was directly related to the presence of the anastomotic leaks and subsequent peritonitis. Explorative laparotomy was an effective diagnostic tool especially in the field hospitals. The overall mortality rate was 3.2%. In our operative strategy we preferred derivation operations in order to decrease major complications due to anastomotic leakage or peritonitis.