The role of primary repair for colonic injuries in wartime

Abstract

Abstract Background The study reviewed an experience of selective primary repair for penetrating colonic injuries incorporating a number of procedures during the 1992–1995 Bosnia-Herzegovina conflict. Methods Of 5370 casualties, 259 (4·8 per cent) had injuries to the colon. The patients were divided into two groups: those who had primary repair and those who needed a colostomy. The patients' records were reviewed to determine the cause of injury (explosive weapons or bullets), the position and type of colon injury, associated injuries, the surgical procedure(s) done, complications related to the colonic wound or its management, and mortality. Results Some 122 (47·1 per cent) patients had primary colonic repair and 137 (52·9 per cent) had a colostomy. One hundred and fifty (57·9 per cent) were injured by explosive weapons, 108 (41·7 per cent) had bullet wounds and one (0·4 per cent) a stab injury. Associated injuries were seen in 249 (96·1 per cent) patients. Complications related to the colonic wound or its management developed in 27 per cent of patients after primary repair and 30 per cent after colostomy. Mortality rates were 8·2 per cent and 7·2 per cent, respectively. Conclusion Primary repair was a safe and effective treatment for penetrating colonic injuries during war.