War rectal injuries with its complications during civil violence in Iraq

Abstract

BackgroundTraumatic injuries to the rectum is not uncommon in war surgery, increasing numbers of rectal injuries were encountered by Iraqi surgeons due nature civil violence in Iraq. Failure of adequate management of such injury can lead to serious complications like perineal and pelvic sepsis and even death. ObjectiveTo define the wound pattern, injury mechanism, incidence, surgical treatment and associated complications of war rectal injuries suffered in the civil violence of Iraq war. Patients and methodsA retrospective study. In all, 3650 war injured patient with penetrating injuries to the pelvis and abdomen were admitted to the Ameria AL-Fallujah Hospital. Anbar, Iraq and the Al-Yarmouk Teaching Hospital, Baghdad, Iraq from Feb. 2004–May 2008. Of these, 62 (1.7%) patients had rectal injuries. ResultOf 62 injured patients, 40 (64, 5%) were civilians injured patients and 22 (35, 5%) were Iraqi military injured patients. 50 males and 12 females. The age ranges from 16 to 58year. The rectal injuries were caused by an improvised explosive device in 40 (64.5%) patients and by individual firearms in 22 (35.5%). The surgical treatment included diversion and distal washout in 13 (21%) patients, diversion in 31 (50%) patients, distal washout, drainage and diversion in 6 (9%) patients, presacral drainage with diversion in 7 (11%) and 5 (8%) patients just suturing of serosa. The complications were found in 36 (58%) of injured patients. No death in this study. ConclusionWar rectal injuries were caused mainly by improvised explosive device. Most of the injured patients were civilians and a minority was military stuff. War injuries of the rectum were successfully managed by proximal fecal diversion, and presacral drainage, recommending that distal washout may be not always necessary in the management of war rectal injuries. Despite that rectal injury still combined with a high rate of complications.