Colon and Rectal Injuries Caused by High Velocity Penetrating Trauma: Can We Stand with the Current Trends?

Introduction: Management of colorectal injuries is still under debate. The purpose of this study was to analyze management and clinical outcome from a cohort of patients with colorectal injuries caused by high velocity missiles. Objectives: This was a retrospective analysis of consecutively collected data from all the war zone casualties with colorectal injuries during a 6 month period from 14th April 2008 at Teaching Hospital, Anuradhapura. Results: 21 patients were treated with colorectal injuries. Mode of treatment included primary repair and anastomosis (57.15%), colostomy (9.52%), primary repair with proximal loop colostomy (33.33%). According to the location of the primary injury to the colon, colostomy was made frequently with rectal injuries (87.5%) vs. colon (15.39%). Morbidity rate was 14.28%. Conclusion: 1) Primary repair was the most common mode of treatment for colonic trauma. 2) Primary repair and proximal loop colostomy was a safe option for rectal trauma. Rajapaksha S K 1, Sirisena K K D2, Dissanayaka A N3, Wijesinghe A4 1Registrar in Surgery, National Hospital, Colombo, 2Consultant Surgeon, Teaching Hospital, Anuradhapura, 3Medical Officer, Teaching Hospital, Anuradhapura, 4Senior House Officer, General Hospital, Trincomalee. Original article The Sri Lanka Journal of Surgery 2009: 27: 13-16 S K Rajapaksha MBBS Registrar in Surgery, National Hospital, Colombo. K K D Sirisena MBBS, MS, FRCS (Edin) Consultant Surgeon, Teaching Hospital, Anuradhapura. A N Dissanayaka MBBS Medical Officer, Teaching Hospital, Anuradhapura. A Wijesinghe MBBS Senior House Officer, General Hospital, Trincomalee. Due to the experience gained during military conflicts in the past, mortality rates following colorectal injuries are reducing since 1950. With the experience of 60% mortality during World War 1, colostomy was mandated in World War II for all colorectal injuries and 30% mortality rates were attributed to this. During the Korean and Vietnam War mortality The management of colorectal injuries is controversial (1,2). Primary repair, resection and anastomosis, resection and end colostomy, primary repair or anastomosis with defunctioning colostomy are the available surgical options. Okies introduced the exteriorization of the repaired segment until healing has been demonstrated, but popularity has been lost due to increased rates of conversion to Introduction colostomy and obstruction (3). Currently the trend is toward primary repair and anastomosis (2, 4).