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Should colon-penetrating small missiles be removed? An experimental study of retrocolic wound tracks

D P Edwards1, D Brown, P E Watkins

  • 1Medical Countermeasures (Trauma and Surgery), Salisbury, United Kingdom.

Journal of Investigative Surgery : the Official Journal of the Academy of Surgical Research
|March 20, 1999
PubMed

Insights

Retrocolic trauma from small fragments contaminates colon tracks with bacteria. Bacterial counts decrease along the track, suggesting wound track excision is not beneficial for penetrating colonic injuries.

Area of Science:

  • Colorectal Surgery
  • Trauma Surgery
  • Bacteriology

Background:

  • Penetrating colonic injuries are a concern in battlefield casualties.
  • Surgical management of colonic trauma focuses on preventing retrocolic infection and promoting wound healing.
  • The risk of retrocolic infection following such injuries requires quantification.

Purpose of the Study:

  • To quantify the risk of retrocolic infection associated with small-fragment colonic injuries.
  • To evaluate the bacteriological contamination extent within colonic wound tracks.
  • To inform surgical decision-making regarding wound track management.

Main Methods:

  • Simulated penetrating colonic injury using steel fragments fired through exteriorized porcine colon.
  • Collection of fragments and wound tracks in 20% gelatin.
  • Quantitative bacteriological examination of fragments and tracks to determine bacterial load (CFU/g).

Main Results:

  • Median bacterial count for complete tracks was 1.2 x 10(4) CFU/g.
  • Bacterial contamination was highest within the initial 1 cm of the wound track.
  • Bacterial counts decreased progressively along the length of the track.

Conclusions:

  • The study does not support wound track excision for retrocolic trauma from penetrating colonic injury.
  • Missile fragment removal is not recommended due to increased local trauma and potential prejudice to colonic wound repair.
  • Current findings suggest conservative management may be optimal for such injuries.

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