Penetrating colonic injuries in wartime; our experiences in Al Yarmouk Teaching Hospital, Baghdad

ABSTRACT

Penetrating trauma is the commonest cause of surgical admissions in Baghdad following invasion to Iraq 2003. In this study, the factors that affect the morbidity and mortality in patients with penetrating colonic injuries were evaluated. Eighty six [86] patients [74 males, 12 females; age range 7 to 60 years] with penetrating colonic trauma, most of them of high velocity injuries were evaluated according to age, gender, type of penetration, trauma location and severity of colonic injury, associated injury, interval between the trauma and definitive operation, hemodynamic status, blood transfusion requirement, fecal contamination, surgical procedure, postoperative complication and mortality. The mechanisms of injuries were bullets injury in 66 [76.74%] patients, blast injury [shell] in 18 [ 20.93%] and stab injury in 2 [2.3%] patients. Injuries were evaluated according to TRISS and PATI [penetrating abdominal trauma index]. Multiple organs injuries found in 68 [79%] patients, wherease only the large bowels injured in 18 [21%] patients. Primary repair was performed in 36 [42%] of the 86 patients, and colostomy was performed in 50[58%] patients. From those with primary closure [36 patients], PATI was over 25 in 10 patients and below 25 in 26 patients. 15 patients had resection segment [destructive injuries, primary anastomosis], 7 patients had more than 25% of colonic wall injuries, and 10 had less than 25%. Symptoms of shock were present in 66 patients at admission, mortality rate was 6.97%. These results suggest that the use of primary closure should be expanded in penetrating colon trauma and that, even with moderate and severe degrees of colon injury, primary closure provides an outcome equivalent to that provided by colostomy. The primary repair of the penetrating colon trauma can be performed confidently in patients with PATI suggests that is should be included along with other injury severity indices in trauma data bases