Gunshot wounds to the colon: predictive risk factors for the development of postoperative complications, an experience of 172 cases in 4 years

Abstract

BackgroundIn our study, we have defined and evaluated risk factors for the development of post‐operative complications in patients with gunshot wounds to the colon. The purpose of the study is to identify the most influential risk factors.MethodsA retrospective study of 172 patients admitted with gunshot wounds to the colon from 17 February 2011 to 31 December 2014. Age, gender, shock upon admission defined by vital signs and haemoglobin level, blood transfusion, injured site of the colon, the colon injury score, faecal contamination, surgical procedure, colon diversion, multiple organ injuries, delay time pre‐operation and duration of the operation were considered as risk factors. All patients were observed for any postoperative complications.ResultsOne hundred and sixty‐six patients (96.5%) were males, and six (3.5%) were female. The mean age was 28.5 years. On admission 104 (60.5%) patients were in shock, 89 (51.7%) required blood transfusion. Forty‐four (25.5%) patients had an injury to the ascending colon, while 53 (30.8%), 13 (7.6%), 23 (13.4%), 21 (12.2%) and 18 (10.5%) patients had an injury in transverse, descending, sigmoid, rectum and multiple colon injuries respectively. A colon diversion was used in 64 patients (37.2%). Post‐operative complications documented in 67 (38.9%) patients, 35 (20.3%) required re‐exploratory laparotomy, while the disability occurred in 18 (10.4%)) cases, and post‐operative mortality was 12 (6.9%).ConclusionSurgeons should be aware that shock state upon admission and blood transfusion are risk factors for postoperative complications in a patient with a gunshot penetrating injury to the colon.

Gunshot bullet trauma of the colon in combat patients injured in hybrid period of Russian-Ukrainian war during 2014-2020

“…In line with Busić et al and Elfaedy et al, we also demonstrated a high incidence of hemorrhagic shock in our patients suggesting such gunshot complications as a common event (10,18). Also, we have shown a higher frequency of hemorrhagic shock in patients injured by hollow-point as compared to shape-stable bullets, which is another evidence of severe trauma from the modern weapon.…”

“…Similar to other reports, the left colon part (i.e. splenic colon exure, descending and sigmoid colon) and middle colon (ascending and descending colon) were frequently injured as compared to other sites (1,10,(20)(21)(22)(23). The importance to note that colon part injury is related to a higher risk of fecal diversion.…”

“…Also, we have shown a higher frequency of hemorrhagic shock in patients injured by hollow-point as compared to shape-stable bullets, which is another evidence of severe trauma from the modern weapon. The higher severity of shock is associated with higher levels of ischemia and hypoxia of colon tissues, which act to increase bacterial colonization, resulting in a higher risk for anastomosis leak or failure (10,19).…”

“…An example of such a modern weapon is a hollow-point bullet, which is a special shaped bullet expanding into multiple smaller projectiles upon impacting the target and causing severe injury to soft tissues and internal organs and could perforate high-class body armors (7,8). Such ballistics might be associated with severe abdominal trauma: multiorgan injury, multiple perforations of the bowel with massive fecal diversion as well as a high risk of bleeding with hemorrhagic shock and retroperitoneal hematomas (9,10). Also, hollow-point bullet ballistic characteristics are also associated with penetrating, but not perforating injury (7,11).…”

Management of the injured bowel: preserving bowel continuity as a gold standard

“…As previously said, one of the most compelling reasons for making a stoma was fecal contamination; yet an increasing number of studies show that, contrary to polytransfusion, fecal contamination is not a risk factor for post-operative complications and should not be a contraindication to primary repair [23].…”