Gunshot colon injuries

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Slide 1 : GUN SHOT INJURIES OF THE COLON Dr. AHMED A. KANDIL, MD, PhD. Consultant Surgeon Head of Surgery Departments Shifa Hospital - Gaza
Slide 2 : INTRODUCTION
Slide 3 : Early in World War I, primary colon repair was used extensively, but it was accompanied with high mortality. Later in the War it was rarely used.
Slide 4 : Near the end of World War II Sir Ogilvie recommended colostomy for all colonic injuries. Subsequent to the Wars, the military expiernce was carried over in civilian practice.
Slide 5 : However, since 1970s, many reports suggested primary colon repair with or without proximal decompression.
Slide 6 : Gradually there was changes in the approches of many trauma centers towards a more definitive primary repair of the injured colon.
Slide 7 : PATIENTS & METHODS
Slide 8 : It is a retrospective study which included 104 patients. They were admitted in Shifa Hospital during the period from 1988 to 1995.
Slide 9 : Their mean age was 22.6 years, ranged between 11 and 50 y. There were 100 males and 4 females.
Slide 10 : After abdominal exploration, the severity of the abdominal injury was assessed by calculation of the PATI. And the severity of the colon injury was assessed by the CIS.
Slide 11 : RISK FACTORS:- 1. Age of patients. 2. Time to operation. 3. Shock on admission.
Slide 12 : 4. Location of the injury. 5. Degree of fecal contamination. 6. Severity of abdominal injury, PATI. 7. Severity of colon injury, CIS.
Slide 13 : PRIORITIES OF TREATMENT Resuscitation. Arrest of bleeding. Removal of fecal contamination.
Slide 14 : APPROCHES TO THE INJURED COLON: 1. Debridement and primary repair. 2. Resection of the injured segment & end to end anastomosis. 3. Colostomy.
Slide 15 : ANTIBIOTICS IN MOST CASES: *Gentamycin * Keflex * Flagyl Started during operations and continued for 5 days post-operative.
Slide 16 : THE COLON IS DIFFERENTIATED INTO: Right colon, including the hepatic flexure. Transverse colon. Left colon, including the splenic flexure.
Slide 17 : RESULTS
Slide 18 : P.R. group: 88 patients Mean age 20.7 y. (12-50 y.) Mean time to op. (66.7 min.) Shock on admission 13 patients (31.8%)
Slide 19 : SITE OF COLON INJURY ( PR) Rt. colon 33 cases (37.5%) Tr. colon 25 cases (28.3%) Lt. colon 30 cases (34.1%) MEAN PATI 20.7
Slide 20 : 78.4% 11.4% 10.2% TREATMENT
Slide 21 : COLOSTOMY GROUP: 16 patients Mean age: 23.4 y (11-55 y.) Time to operation: 74 min. Shock on admission: 6 patients PATI 28.6
Slide 22 :
Slide 23 : TYPES OF COLOSTOMY Loop colostomy……………… 10 cases End colostomy………………… 5 cases Abdominoperineal resection….1 case
Slide 24 : COMPARISON BETWEEN PR & C GROUPS Table 1: Compare the treatment methods. Table 2: Compare the complications. Table 3: Compare the period of hospitalization.
Slide 25 : (1) SITE OF INJURY P.R. RT. HEMI R-A C TOTAL RT. colon 22 10 1 1 34 TR. colon 19 0 6 2 27 LT. colon 28 0 2 13 43
Slide 26 : (2) COMPLICATIONS P.R. C. Wound infec. 10(11.4%) 7(43.8%) Abd. abscess 2(2.3%) 4(25%) Fecal fistula 3(3.4%) 1(6.3%) Burst abdomen 1(1.1%) 12(12.5%) Inc. hernia 6(7.0%) 3(18.8%)
Slide 27 : (3) AVARAGE PERIOD OF HOSPITALISATION Primary repair…………………15.4 days Colostomy…………………….. 62 days For colostomy closure………. 12.1 days
Slide 28 : CONCLUSIONS
Slide 29 : Primary colon repair associated with significant less septic related complications than colostomy. The period of hospitalization for PR are significantly less than those treated by colostomy.
Slide 30 : Shock on admission. blood transfusion. Left sided colon injuries. High PATI >25 and colon injuries Grade III and IV are not a contraindications for primary repair.
Slide 31 : These guidelines will increase the number of primary repairs for colon wounds, thus reducing the morbidity and cost associated with creation and subsequent closure of colostomy.
Slide 32 : Thank You

 


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