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.