RESULTS OF SURGICAL TREATMENT OF FIRE WOUNDS OF COLON

The aim of the study. Evaluate the results of surgical treatment of wounded with gunshot wounds of the colon. Materials and methods of research. A retrospective analysis of the results of surgical treatment of 32 wounded with gunshot wounds of the colon, who were treated in the Central Medical Center and area of responsibility (II–IV level of medical care) from 2014 to 2017. Damage to the right half of the colon was observed in 12 wounded (37.4 %), the left half — in 17 (53.2 %), the rectum — in 3 (9.4 %). A differentiated approach to surgical treatment of colon injuries of different localization is applied. Results and discussion. The method of multi-stage surgical treatment “Damage Control Surgery” was used in 12.5 % of patients. The most common complications of the injury were adhesive intestinal obstruction in 6.3 % of cases, the formation of intestinal abscesses — in 6.3 %, the development of post-traumatic pneumonia in 25 % of patients. Conclusions. If the tactics of “Damage Control Surgery” are followed, it is possible to improve the results of surgical treatment of colon injuries in severe and extremely severe patients.

Management of the injured bowel: preserving bowel continuity as a gold standard

Background Management of bowel traumatic injuries is a challenge. Although anastomotic or suture leak remains a feared complication, preserving bowel continuity is increasingly the preferred strategy. The aim of this study was to evaluate the outcomes of such a strategy. Methods All included patients underwent surgery for bowel traumatic injuries at a high volume trauma center between 2007 and 2017. Postoperative course was analyzed for abdominal complications, morbidity and mortality. Results Among 133 patients, 78% had small bowel injuries and 47% had colon injuries. 87% of small bowel injuries and 81% of colon injuries were treated with primary repair or anastomosis, with no difference in treatment according to injury site (p = 0.381). Mortality was 8%. Severe overall morbidity was 32%, and abdominal complications occurred in 32% of patients. Risk factors for severe overall morbidity were stoma creation (p = 0.036), heavy vascular expansion (p = 0.005) and a long delay before surgery (p = 0.023). Fistula rate was 2.2%; all leaks occurred after repairing small bowel wounds. Conclusion Primary repair of bowel injuries should be the preferred option in trauma patient, regardless of the site—small bowel or colon—of the injury. Stoma creation is an important factor for postoperative morbidity, which should be weighed against the risk of an intestinal suture or anastomosis.

Primary Anastomosis versus Colostomy in Patients with Penetrating Colonic Injuries; A Comparative Study

Background: Penetrating colon injuries treatment has been a controversial topic of discussion in medical literature. The literature shows that randomized trials comparing primary repair versus bypass showed no significant difference in complication rates between the two groups. While other trials comparing complication rates between the two groups showed that the primary repair has lower complication rates as compared to the colostomy. Methodology: Randomized control trail was conducted in six months of duration from 1stJanuary 2020 to 31stDecember 2020in surgical unit of DHQ Teaching Hospital / SMC (UOS), Sargodha. After taking Ethical approval from the hospital, the study was conducted on 300 patients sample size calculated through open Epi sample size calculator with margin of error 5% and confidence interval 95%. Randomized blotting technique was used for randomization to overcome biasness. Results: Group 01 of primary anastomosis had 97 (64.67%) males and 53 (35.33%) females while group 02 of colostomy had 92 (66.34%) males and 58 (33.66%) females. complications intra-abdominal abscess was analyzed between both groups. In group 01 primary anastomosis, only 4 (2.66%) patients develop intra-abdominal abscess while in rest of patients i.e. 146(97.34%) showed efficacy to primary anastomosis. In group 02 of colostomy, 27 (18%) patients develop intra-abdominal abscess while rest of patients i.e. 123(82%) patients showed efficacy towards colostomy. Conclusion: In penetrating colon injuries, anastomosis showed more efficacy, safe to use and excellent results on the basis of post-operative complications as compared to colostomy. Keywords: Primary anastomosis, defunctioning in colostomy, penetrating colonic injuries, effectiveness