Bullets and their role in sepsis after colon wounds

The objective of this study was to determine the relation between the presence of a bullet (gunshot) after injury to the colon and the incidence of sepsis in its track and the soft tissue where it is retained. A retrospective review was carried out of the charts of consecutive patients admitted for abdominal gunshot wounds with proved colon injury during laparotomy where the bullet was either retained in the soft tissue or exited the body. The review covered a period of 4 years beginning January 1, 1990. Three groups were identified for analysis: (1) patients from whom the bullet was surgically removed, with additional cleansing and debridement of the area (n = 21); (2) patients who did not undergo surgical removal of the bullet (n = 81); and (3) patients in whom the bullet exited spontaneously and in whom only débridement of the skin was carried out (n = 83). Similar risk factors were noted among the groups (age, ATI score, colostomy rate), except for a higher incidence of shock in group 3 (p = 0.003). The incidence of sepsis in soft tissue was least in group 1. It was five and seven times greater in groups 2 and 3, respectively. After an abdominal gunshot with colon injury, the missile should be removed if feasible and the local tissue débrided. If the bullet has exited spontaneously, its internal track must be débrided and lavaged extensively.