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Multiple Colonic Injuries: For Grading and Universal Management Plan

Yisar Said Salaam

Wounds of the colon and rectum resulting from penetrating or blunt trauma are commonly encountered in civilian and War circumstances. Prior to the World War II, this type of injury was associated with significant mortality and morbidity.

Objective: Our main objective is to demonstrate the presence of multiple injuries of the colon due to gunshot wounds as a definite clinical and operative entity and to evaluate its prevalence in clinical practice.

Design/methods: This study has been conducted in 6 months period from October 2016 to March 2017, in a general hospital close to Saudi-Yemeni borders in a war zone. This study included 23 patients presenting with gunshot injuries of the abdomen and colon was injured in all of them .In this study, patients were managed according to ATLS guidelines and sent to or for laparotomy. Full exploration of the abdominal organs and viscera was done. Cases with colon injuries were involved in the study where we evaluate the site of injuries and the number of injuries as well as the grade of colon injury according to AAST grading system. Surgical management was done by primary repair, excision with colostomy or excision with anastomosis. Patients were followed in the postoperative period where complications were reported.

Results: Patients were at the age range of 19 to 39 years with a mean of 26.65 ± 4.49 years. The most common part of the colon injured was the left colon (60.9%) followed by the right colon (17.4%), the transverse colon (13.0%), and the ceacum (8.7%). Colonic injuries were graded according to the American association of trauma scale, where grade 1 injury was seen in 1 patient (4.3%), grade 2 was found in 6 patients (26.1%) grade 3 in 6 patients (26.1%), grade 4 in 6 patients (26.1%), while 4 patients sustained multiple perforations of the colon in a percentage of 17.4 which is a significant percentage.

Conclusion: Multiple injuries of the colon are frequently seen in gunshot injuries due to the use of shotgun weapons. These types of injuries are managed on individual basis with wide variety of results, which may be due to absence of proper grading and management guidelines.