Large bowel perforations in war surgery: one-stage treatment in a field hospital

Abstract

Over a period of 14 months between 1990 and 1992, 73 Afghan war wounded with penetrating colon injuries were admitted and treated by a single surgical team in a field hospital of the International Committee of the Red Cross (ICRC). There were 67 males and 6 females, with a mean age of 23 years (range 6 to 80 years). Fifty six (77%) patients had multiple associated injuries; admission was delayed longer than 12 hours in 39 (44%); hypotension or deep shock was present at admission in 34 (47%) and 12 (16%) respectively. At laparotomy faecal contamination was limited to one quadrant in 58 (79.5%) cases and major in 15 (20.5%). Fifty-two (71.2%) patients underwent resection and primary anastomosis and 21 (28.8%) primary repair. Exteriorisation or diverting colostomy were never used. Four (5.5%) patients died and 11 (15%) had postoperative complications. Overall failure rate was 2.7%, including one faecal fistula conservatively treated and one colostomy raised as a precaution in a patient undergoing relaparotomy for intra-abdominal abscess. No primary repair leaked Deaths were significantly related to delay in admission and age, but not to surgical treatment. One stage primary treatment of large bowel injuries from penetrating abdominal wounds has low mortality, failure and colostomy rates suggesting its wider use regardless of risk factors.

Outcomes of Primary Repair and Primary Anastomosis in War-Related Colon Injuries

“…[12][13][14][15] The present study describes the outcomes of PR and primary anastomosis (PA) in patients injured during the current conflicts in Iraq and Afghanistan and factors associated with failure of PA or PR. Damage control surgery was often performed in these patients and the role of damage control and PR or PA was also investigated.…”

Colon and Rectal Injuries During Operation Iraqi Freedom: Are There Any Changing Trends in Management or Outcome?

“…[6][7][8][9][10] Wartime series were slower to mimic the civilian trauma experience, but similarly demonstrated that not all colorectal injuries required a colostomy, with equivalent morbidity and mortality rates. [11][12][13] Despite the abundance of evidence, colorectal injuries continue to be a source of not only significant morbidity and mortality but also ongoing debate about the correct management strategy. Although many civilian and military surgeons are more apt to avoid fecal diversion in a controlled setting, when faced with a large amount of destruction, multiple injuries, or wartime environment, management practices may change.…”

Primary Repair or Fecal Diversion for Colorectal Injuries After Blast: A Medical Review

“…However, authors of each of the three papers reported that PR did not present complications or mortality that were statistically different from fecal diversion (Tables 1 and 2). [4][5][6] Limitations The primary limitation for the review was a lack of substantial data such that quantitative analysis could be conducted. In addition, articles retrieved for the review were not consistent in reporting of data.…”