Performance of primary repair on colon injuries sustained from low-versus high-energy projectiles

Abstract

Among various reasons, colon injuries may be caused by low- or high-energy firearm bullets, with the latter producing a temporary cavitation phenomenon. The available treatment options include primary repair and two-stage management, but recent studies have shown that primary repair can be widely used with a high success rate. This paper investigates the differences in performance of primary repair on these two types of colon injuries. Two groups of patients who sustained colon injuries due to single gunshot wounds, were retrospectively categorized based on the type of bullet. Primary colon repair was performed in all patients selected based on the inclusion and exclusion criteria (Stone and Fabian's criteria). An almost absolute homogeneity was attained among the groups in terms of age, latent time before surgery, and four trauma indexes. Only one patient from the low-energy firearm projectile group (4%) developed a postsurgical complication versus nine patients (25.8%) from the high-energy group, showing statistically significant difference (p = 0.03). These nine patients experienced the following postsurgical complications: pneumonia, abscess, fistula, suture leakage, and one multiorgan failure with sepsis. Previous studies concluded that one-stage primary repair is the best treatment option for colon injuries. However, terminal ballistics testing determined the projectile's path through the body and revealed that low-energy projectiles caused considerably lesser damage than their high-energy counterparts. Primary colon repair must be performed definitely for low-energy short firearm injuries but very carefully for high-energy injuries. Given these findings, we suggest that the treatment option should be determined based not only on the bullet type alone but also on other clinical findings.

Revisión normativa y conceptual relacionada con la incapacidad medicolegal en Colombia

“…Para los casos de fracturas, los factores independientes del paciente incluyen el patrón de fractura, la ubicación y el desplazamiento, la gravedad de la lesión de los tejidos blandos, el grado de pérdida ósea, la calidad del tratamiento quirúrgico y la presencia de infección [36]. El nivel de energía empleado en la lesión, con proyectiles de alta o baja energía, influye en la posibilidad de reparaciones primarias sobre lesiones colónicas [37], así como la proporción de fragmentos de proyectil alojados cerca del foco de la fractura [38]. El retraso de la reparación de las fracturas y las no uniones implican toma de decisiones clínicas y quirúrgicas, así como un aumento de los costos directos por los tratamientos y de los indirectos.…”