LARGE-BOWEL PERFORATIONS IN WAR SURGERY - ONE-STAGE TREATMENT IN A FIELD HOSPITAL

Over a period of 14 months between 1990 and 1992, 73 Afghan war wounde d with penetrating colon injuries were admitted and treated by a singl e 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 a ge of 23 years (range 6 to 80 years). Fifty six (77%) patients had mul tiple 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 wa s limited to one quadrant in 58 (79.5%) cases and major in 15 (20.5%). Fifty-two (71.2%) patients underwent resection and primary anastomosi s and 21 (28.8%) primary repair. Exteriorisation or diverting colostom y were never used. Four (5.5%) patients died and 11 (15%) had postoper ative complications. Overall failure rate was 2.7%, including one faec al fistula conservatively treated and one colostomy raised as a precau tion in a patient undergoing relaparotomy for intra-abdominal abscess. No primary repair leaked Deaths were significantly related to delay i n admission and age, but not to surgical treatment. One stage primary treatment of large bowel injuries from penetrating abdominal wounds ha s low mortality, failure and colostomy rates suggesting its wider use regardless of risk factors.