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Surgical management of colorectal injury in war

Czech version

Authors: T. Dušek 1,2;  J. Kotek 1,2;  P. Lochman 1,2
Authors‘ workplace: Katedra vojenské chirurgie, Fakulta vojenského zdravotnictví, Univerzita obrany, Hradec Králové, Česká republika 1;  Chirurgická klinika Fakultní nemocnice Hradec Králové a Lékařská fakulta Univerzity Karlovy v Hradci Králové, Česká republika 2
Published in: Rozhl. Chir., 2023, roč. 102, č. 8, s. 321-326.
Category: Review
doi: https://doi.org/10.33699/PIS.2023.102.8.321–326

Overview

The rate of colorectal trauma is 5–10 % in modern war conflicts. The most common causes include gunshots or shrapnel injuries; the contusion-laceration mechanism occurs in sporadic cases in the war zone. Despite modern surgical procedures, however, it is associated with a high rate of morbidity, especially if it is not diagnosed and treated in time. Surgical management is specified by simple scoring schemes – the colon injury scale, rectal injury scale and the Flint grading system. Colonic resection with primary or delayed anastomosis is not associated with a higher risk of complicated healing and is nowadays preferred over the construction of terminal stomas. These are indicated only for cases with severe hemodynamic instability in traumatic-hemorrhagic or septic shock with severe diffuse peritonitis. Trauma to the intraperitoneal segment of the rectum is treated in the same way as trauma to the colon. An extraperitoneal rectal injury without soft tissue devastation can be treated with or without a transanal suture. On the contrary, devastating injuries to the rectum including the pelvic soft tissues should be primarily controlled with a stoma with delayed reconstruction. Presacral drainage or rectal stump lavage are no longer recommended.

Keywords:

colon injury – rectal injury – penetrating abdominal injury – war injury

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Labels
Surgery Orthopaedics Trauma surgery
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Perspectives in Surgery

Issue 8
2023 Issue 8
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