EC Clinical and Medical Case Reports

Introduction: Colon wounds during ballistic trauma are often associated with other severity factors responsible for significant morbidity and mortality. In seriously injured people, diversion in colostomy is preferable to one-time surgery. Our goal is to identify the prognostic factors that have determined the occurrence of septic complications and mortality after surgery.

Methods: In this retrospective study, the ballistic wounds of the colon (Flint grade 3) managed during the period (1999 - 2005) at the Regional University Military Hospital of Constantine, either by ideal surgery and immediate recovery or by initial externalization of the digestive segments, were reviewed. Indications, mortality, septic complications, and early surgical revisions were analysed.

Results: Eighty-one male patients operated on for colon wound (Flint grade 3) were included in this study. 93% of patients had hemorrhagic shock, 70% had peritonitis and 84% had extra-abdominal lesions. 58% of patients had colonic surgery in one time, and 42% had a colostomy. 41 patients were referred to our department after surgery in other hospitals, 70% had postoperative peritonitis. Surgical exploration has highlighted in addition to the release and disunions of digestive sutures other unknown lesions. The incidence of peritonitis by anastomotic release was 77% in the case of one-stage repair and 22% in the case of two-stage surgery (p < 0.0001). Mortality is influenced by the existence of associated extra-abdominal lesions 22% and early recovery or mortality rate is around 44.5% (P < 0.001).

Conclusion: The treatment of colon wounds during severe ballistic trauma must meet the requirements of emergency surgery. The ideal treatment should be reserved for favourable cases (recent and single lesions).

Keywords: Ballistic Colon Trauma; Primary Surgery; Colostomy; Mortality

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