Penetrating colorectal injuries in war

Introduction: Colorectal war injuries can be treated with primary repair or by colostomy. We report our experience with both treatments. Methods: Duri ng the Croatian war from July 1991 to March 1994, 155 patients with colorec tal injuries were treated at the Surgical Clinic, University Hospital Split . This group represents 7% of all patients (n = 2220) with gunshot and shra pnel wounds treated in this period at our clinic. The median patient age wa s 24.7 years (range 14-70 years). The majority of the patients (96,7 %) wer e male. Concomitant injuries of the colon (83.7%) and rectum (69 %) were fo und more frequently than isolated ones. 50 patients were operated on as eme rgencies in our clinic, while 105 were operated on in field hospitals. In 2 8 patients primary repair of the colorectal injury was performed (without d erivation), whereas 127 patients were treated by colostomy. In those patien ts 106 wounds were dosed electively during a second operation. The average in hospital stay was 32.3 days (range 10-65 days). Results: Using PATI and FCIS scores for colorectal injuries, 80 % of our patients had life-threaten ing injuries. In the cases with primary repair the percentage of complicati ons was high (92 %). In the cases with the diverting colostomy it was only 34 %. The high complication rate in the cases with primary repair was direc tly related to the presence of the anastomotic leaks and subsequent periton itis. Explorative laparotomy was an effective diagnostic tool especially in the field hospitals. The overall mortality rate was 3.2 %. Conclusion: In our operative strategy we preferred derivation operations in order to decre ase major complications due to anastomotic leakage or peritonitis.