Оrgan-preserving operations in the abdominal gun-shot penetrating woundings of large bowel. Experience of the medical help delivery in military environment Аntiterroristic operation/The Joint Forces Operation

Abstract

Objective. To improve the results of treatment in injured persons with a gun-shot penetrating abdominal woundings with damages of large bowel, using introduction of principle for compliance between volumes of the damage and the primary operative intervention through organ-preserving operations.
 Materials and methods. There were analyzed 164 gun-shot abdominal woundings of large bowel in 151 injured persons. All the wounded persons were men, aged from 19 to 58 yrs old, (34 ± 5.2) yrs old at average. Penetrating cross-cutting abdominal woundings have occurred in 48 (31.8%) patients, the blunt – in 103 (68.2%). In accordance to character of the large bowel damage there were: deserozation - in 8 (5.3%) injured persons, the blunt wounding – in 57 (37.7%), and a through one – in 86 (57.0%). The bullet woundings have occurred in 31 (20.5%) injured persons, while the comminuted – in 120 (79.5%). The large bowel woundings have had following localizations: coecum – in 37 (24.5%) patients, ascending colon – 19 (12.6%), transverse colon – 32 (21.2%), descending colon – 18 (11.9%), sigmoid colon – 33 (21.9%), and several perts of large bowel – 12 (7.9%). The wounded persons were distributed into two groups, depending on volume of the operative intervention performed: the main – 49 (32.4%) wounded persons, in whom organ-preserving operations were performed, and a control one – 102 (67.6%) wounded persons, in whom resectional methods were applied. The large bowel wall defects suturing with or without formation of unloading colo- or enterostomy were considered as organ-preserving operations.
 Results. Definite decision, concerning the operative intervention volume, was made immediately after revision of the abdominal cavity organs, estimation of the damages character (special attention was drawn to dimensions, localization and quantity of intestinal defects, the state of its mesenterial edge and adequacy of a blood flow), presence and remoteness of extended peritonitis, general state of a wounded person (the blood loss volume, the sepsis features presence, hemodynamicac indices and common character of the woundings). Оne or several woundings of large bowel, including big in dimensions, were considered as indications for performance of organ-preserving operations (the intestinal wound suturing, the intestinal wound suturing with colo- or jejunostomy, extraperitonization). In patients of the main group, comparing with those of the control group, the stationary stay and the complications rate were reduced. After rehabilitation and staged closure of unloading stomas all wounded persons of the main group went back to service in Military Forces of Ukraine.
 Conclusion. Selecting the surgical treatment method for the gun-shot woundings of large bowel, it is necessary to base on complex analysis of the battle trauma character, the patient’s state and the risk for іntra- and postoperative complications. The first-line application of organ-preserving interventions as more physiological and those, which permit mostly rapid come back to the service duties functioning, is expedient. While choosing the organ-preserving operation volume, the surgeon must adhere to principle of compliance between the damage volume and prevalence, general state of a wounded person and the operative intervention volume.