[Personal experience with unconventional treatment in extraperitoneal injuries of the rectum].

UNLABELLED Because of the unannounced war state in Bosnia and Herzegovina in the period 1992-1995, there were overlapping of war and peaceful doctrine of taking care of all injuries. Many extraperitoneal and intraperitoneal injuries of colon and rectum were treated in the Cantonal Hospital Zenica and in the other war hospitals where the staff of Cantonal Hospital Zenica worked. According to the war doctrine all injuries of colon and rectum are treated operatively with obligatory making colostoma. This presentation includes 7 cases of extraperitoneal rectum injuries from great number of intra- end extraperitoneal injuries of rectum and injuries of colon, which were not treated by principles of war doctrine. We emphasize that surgical teams were experienced, had diagnostic equipment and operation hall with staff and equipment in the case of reintervention. THE AIM Of this presentation is to point out the size of lesion and the association with the other injuries in order to decide about operative or conservative way of treatment as alternative method. It was necessary to define the patients in which we would avoid colostoma with adequate drainage procedures, first of all looking at the size of lesion and the association with the other injuries. THE MAIN DIAGNOSTIC PROCEDURE Was rectoscopic verification of all 7 injuries with the presentation of size of lesion. THE MAIN METHOD OF TREATMENT Was high grade quality, continuous and adequate toilette and drainage of canal of injury and perirectal area following with antibiotics (metronidasol) and stool regulation. In comparison with doctrinal treatment by making colostoma there was no significant more complications and lethal outcome by this alternative method of treatment. CONCLUSION Six of seven cases of extraperitoneal rectum injuries with lesion not bigger than 30 mm and with small pelvis mutilation were solved using conservative method (not making colostoma).