Retroperitoneal Hematoma as a High-Risk Factor for the Development of Infection Complications in Patients with Colon Damage Due to Combat Penetrating Abdominal Injury (Data of Joint Forces Operation in Ukraine)

Abstract

INTRODUCTION: Development of retroperitoneal hematoma (RH) accompanies 20% to 33% of penetrating abdominal injuries and almost never occurs isolated. It is usually accompanied by damage to other abdominal organs, which, in turn, affects the general condition of the patient and the development of complications, the probability of which reaches 20%. METHODS: An analysis was performed on 208 servicemen with penetrating gunshot wounds to the abdomen, which they received in eastern Ukraine from 2014 to 2021 and had colon injuries. All the wounded were male, aged 18 to 55. The average age was 33.2 ± 8.8. The wounded were operated. RH was diagnosed in 44 (21.2%) patients with colon damage. The distribution, depending on the severity of damage and RH zone to the colon is shown in the Table. Table. - Distribution of Retroperitoneal Hematomas by Zones, Depending on the Severity of Damage to the Colon Variable Zone 1 (central retroperitoneal space from the diaphragm above to the bifurcation of the aorta below) Zone 2 (lateral paranephric areas of the upper retroperitoneal department from the renal vessels medially to the lateral border of the parietal peritoneum) Zone 3 (below the aortic bifurcation) Grade I (contusion or hematoma without devascularization, partial thickness, no perforation) 3 0 1 Grade 2 (laceration < 50% of circumference) 3 8 4 Grade 3 (laceration > 50% of circumference without transection) 4 7 1 Grade 4 (transection of the colon) 0 1 4 Grade 5 (transection of the colon with segmental tissue loss, devascularized segment) 1 4 3 Total 10 cases (22.7%) 21 cases (47.7%) 13 cases (29.6%) RESULTS: From 44 wounded who had RH, 31 (65.9%) had complications, and 28 (63.6%) had infectious complications (IC; retroperitoneal abscesses and phlegmons of the retroperitoneal space). Among those wounded in whom RH was opened and drained during the primary operation (n = 5) IC were not observed. While among those who did not have a hematoma revision (n = 39), 28 wounded (71.8%) had IC. Wounded with damage to the colon without RH, the incidence of IC of the abdomen reached 23.2% (38 people from 164 who had damage to the colon without RH). CONCLUSION: The presence of RH in colonic damage in wounded with combat penetrating abdominal trauma is accompanied by a high risk of abdominal IC (63.6% in patients with RH vs 23.2% without, p ≤ 0.05).