Gunshot injury to the colon by expanding bullets in combat patients wounded in hybrid period of the Russian-Ukrainian war during 2014–2020

Abstract

Background A gunshot wound to the colon is a frequent injury in armed conflicts. An example of a high-energy modern weapon is hollow-point bullets, which is associated with increased tissue damage and lethal outcome. The aim of this study was to evaluate gunshot injuries to the colon in combat patients and to assess the difference in clinical features of patients with colon injuries by hollow-point versus shape-stable bullets. Patients and methods Analyses of clinical data were performed on 374 male soldiers from the Armed Forces of Ukraine with gunshot abdominal wounds with injury to the colon in East Ukraine between 2014 and 2020. Out of 374 injured, 112 (29.9%) patients were diagnosed with penetrating gunshot bullet wounds: 69/112 (61.6%) were injured by shape-stable bullets, and the hollow-point bullets injured 43/112 (38.4%) patients. Results More severe hemorrhagic shock stages were in patients injured by hollow-point bullets: shock stages III-IV was in 25 (58.1%) patients injured by the hollow-point bullets vs. 17 (24.6%) patients injured by shape-stable bullets (p = 0.0004). Left colon parts were more frequently injured as compared to the right colon side or transverse colon: 21 (48.8%) patients were injured by the hollow-point bullets (p < 0.0001), and 41 (59.4%) patients were injured by the shape-stable bullets (p = 0.032). A significant difference was identified for the frequent injury to the middle colon within the entire cohort (p = 0.023). Patients injured by the hollow-point bullets demonstrated a higher frequency of 3–5 areas of colon gunshot defects, which was detected in 18 (41.8%) patients injured by hollow-point bullets and none with shape-stable bullets injury (p = 0.0001). Colon Injury Scale (CIS) IV was detected in 7 (16.3%) patients injured by the hollow-point bullets as compared to 2 (2.9%) patients injured by shape-stable bullets (p = 0.011). Colostomy was performed in 14 (69%) patients injured by shape-stable bullets and in 12 (27.9%) patients injured by hollow-point bullets (p > 0.05). 15 (35%) patients died after injury by the hollow-point bullet, whereas 9 (13%) patients after damage by the shape-stable bullets (p = 0.0089). Conclusions All patients should be suspected to have an injury by bullet with expanding properties in case of penetrating abdominal injury (absent of outlet wound) and careful revision of the abdomen must be performed to identify possible multiorgan injury as well as multiple gunshot defects of the intestine.

Retrieval of ferromagnetic fragments from the lung using video-assisted thoracoscopic surgery and magnetic tool: a case report of combat patient injured in the war in Ukraine

“…In this case report, we presented our clinical experience in the management of gunshot wounds with the application of VATS with magnet guidance to remove ferromagnetic fragments in combat patient. We believe this case report provides additional knowledge about the role of minimally invasive surgery and the magnets in the active war conditions accompanied by the violation of humanitarian law by the Russian army and in terms of limited medical resources in Ukraine [ 2 , 14 , 15 , 17 ]. In regards to our previous reports, management of gunshot injury to the lungs is presented for the first time in the patient injured during the active (invasion) period of the Russo-Ukrainian war.…”

“…The shelling trauma was judged as severe because it was penetrating body armor and caused bleeding from the chest. The patient received medical aid at the place of injury according to the principles of damage control surgery and in line with the levels system of medical care as shown in our previous reports [ 2 – 4 , 14 , 16 , 17 ]. One hour after the injury, the patient was evacuated to Level II, and forward surgical team (FST) performed primary surgical debridement of the gunshot wounds, including the application of drainage for chest decompression.…”

“…Open thoracotomy is the method of choice in gunshot injuries to the chest, and video-assisted thoracoscopic surgery (VATS) is uncommonly applied to remove foreign bodies [ 8 – 13 ]. It is also important to mention that the Armed Forces of Ukraine and civil people are in permanent violation of international humanitarian law during the war by the Russian army because of such high-energy weapons as artillery strikes, cruise missiles, and drone attacks on medical facilities, causing significant problems for the safe evacuation of wounded to appropriate levels of medical care and interruption in supplying of medical goods [ 2 , 14 – 17 ]. The management of all kinds of wounds is a difficult task for both civil people and military personnel under the abovementioned conditions.…”

Modeling of wound ballistics in biological tissues simulators

“…A specific feature of such gunshot wounds is related to the kind of bullets to be made with a changed center of gravity type 5.45x39 PS (7N6M) and expansive characteristics of the bullets (hollow-point bullets) type 5.45x39 V-max as also shown in other studies of gunshot trauma [2,10,11,12,13,14]. The consequences of the application of the abovementioned types of bullets showed in the clinical photographs (Fig.…”

“…The severity of gunshot wounds is increasing due to frequent traumatic shock, multiple organ failures, and high mortality [1]. The active phase of russia's war against Ukraine is demonstrated new challenges to military surgeons because of the high incidence of severe gunshot wounds due to the frequent application of high-energy weapons as well as modified bullets [2,3]. Our experience from the patient's management during russia's invasion showed some specific features of such gunshot wounds such as severe functional 23/ Том XXVIII / 1 disorders, an increased frequency of complications, and a high mortality rate [3,4,5,6,7,8,9].…”