Colorectal war injuries

Area of Science:

• Trauma Surgery
• Colorectal Surgery
• Military Medicine

Background:

• The Croatian War of Independence (1991-1995) resulted in numerous casualties requiring surgical intervention.
• Abdominal injuries, particularly those involving the colon and rectum, present significant challenges in trauma care.
• Understanding injury patterns and treatment outcomes is crucial for improving battlefield surgical practices.

Purpose of the Study:

• To analyze the incidence, location, and management of colon and/or rectum injuries in war casualties.
• To evaluate the surgical treatment strategies and outcomes, including mortality rates.
• To identify common patterns of associated injuries in patients with colorectal trauma.

Main Methods:

• Retrospective analysis of 851 war casualties treated at Rijeka Clinical Hospital.
• Detailed review of 66 patients with colon and/or rectum injuries.
• Documentation of injury sites, associated organ damage, surgical procedures, and outcomes.

Main Results:

• Colon and/or rectum injuries were identified in 7.8% (66/851) of war casualties.
• Most frequent injury sites were the right colon (30.3%) and sigmoid colon (31.8%).
• Jejunum and ileum were the most common associated intra-abdominal injuries (24.2%).
• Surgical treatment was initiated within 3 hours for all patients.
• Relieving colostomy was performed in 89% of cases post-resection; 11% had primary repair.
• The overall mortality rate was 3%, primarily due to severe multi-organ trauma and brain injury.

Conclusions:

• Colon and rectum injuries are significant components of war-related abdominal trauma.
• Prompt surgical intervention and the judicious use of colostomy are vital for managing these injuries.
• Associated injuries, particularly to the small bowel, frequently complicate colorectal trauma management in wartime settings.