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

BACKGROUND: In 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. METHODS: A 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. RESULTS: One 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%). CONCLUSION: Surgeons 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.

The management of hepatobiliary cystadenomas: lessons learned.

BACKGROUND: Mucinous cystic neoplasms of the liver (hepatobiliary cystadenomas) are rare neoplastic lesions. Such cysts are often incorrectly diagnosed and managed, and carry a risk of malignancy. The objective of this study was to review the surgical experience with these lesions over 15 years. METHODS: A retrospective chart review identified consecutive patients undergoing surgery for liver cystadenomas from 1997-2011. Clinical data were collected and summarized. RESULTS: Thirteen patients (mean age 51 years, 12/13 females) with cysts 4.6-18.1 cm were identified. Most cysts were located in the left lobe/centrally (11/12) and had septations (8/13). Mural nodularity was infrequent (3/13). Nine patients had liver resection/enucleation, whereas four had unroofing. Frozen section analysis had a high false-negative rate (4/6). All patients had cystadenomas, of which two had foci of invasive carcinoma (cystadenocarcinoma) within mural nodules. There was no 90-day mortality. All but one patient (myocardial infarction) were alive at a median follow-up of 23.1 months. No patient with unroofing has developed malignancy to date. CONCLUSIONS: Non-invasive hepatobiliary cystadenomas present as large central/left-sided cysts in young or middle-aged women. Associated malignancy was relatively uncommon and found within mural nodules. Intra-operative frozen section analysis was ineffective at ruling out cystadenomas. Complete excision is recommended, but close follow-up might be considered in patients with a prohibitive technical or medical risk, in the absence of nodularity on high-quality imaging.