Definitive Surgery of the Large Intestine Following War Wounds

Abstract

AT THE TIAIE of World War I modern colon surgery had reached only its first great milestone. The contributions of Heinecke, Block,' Paul,2 and Mikulicz,3 resulting in the development of the Paul-Mikulicz technic had allowed surgeons of that day to attack the diseases of the colon with some clhance of success. However, surgeons prepared only with a surgical technic and without modern chemotherapeutics and antibiotics were unable adequately to cope with the casualties sustaining wounds of the colon or rectum in that war. Wounds of the colon constituted 22%o and wounds of the rectum 2.4% of all thie intra-abdominal visceral injuries in the United States Army in World War I, and carried a mortality rate of 59.6% and 45.19%0, respectively.4 Complete statistics are not yet available for World War II but it is safe to state that one of the most impressive achievements of the military surgeon will be in the lowered mortality rates for intra-abdominal wounds in general, and particularly wounds of the colon and rectum. It is reasonable to expect that when the final figures are published the mortality rates for these three types of wounds may approach one-third the rate in World War I. The many factors contributing to these favorable results have received ample publicity and description. The use of sulfonamides, penicillin, plasma and blood transfusions, rapid evacuation and prompt treatment at forward medical installations have all received due credit. However, one of the most important factors in reducing the death toll of colon and rectal wounds has not received its due recognition, namely, the routine establishment of a temporary colostomy in all wounds of the colon, rectum, and certaini perineal and buttocks wounds. Shortly after the close of the North African campaign the Surgeon-General5 lhad the wisdom to issue a directive that all wounds involving the large bowel should be exteriorized, if possible, as a temporary colostomy, otherwise sutured and a proximal colostomy established, and in certain perineal and buttocks wounds it was directed that a colostomy be performed as adjuvant to wound hiealing and secondary suture. The strict adherence to this directive has mate