A COMPARATIVE ST UDY OF THERAPEUTIC RESULTS OF RIGH T AND LEFT COLONIC INJURIES SUSTAINED BY IRANIAN SOLDIERS IN THE IRAN-IRAQ WAR

The treatment strategy of colonic injuries is a debatable and highly controversial subject worldwide in various medical centers. The method of treatment of left and .. right colonic injuries, diversity or similarity in their management and particularly differences between the treatment of war-associated injury from other types of colonic damage are among the unsettled issues. The present study involves a review of 226 medical records belonging to male Iranian soldiers 15-54 years of age admitted to 3 hospitals affiliated to Shiraz University of Medical Sciences for injuries sustained during eight years of the Iran-Iraq war. Differences with respect to therapeutic results, symptoms and mortality rates were studied between the two groups of patients with left and right colonic injury with reference to the various surgical treatments employed. Ninety two (40.7%) and 134 (59.3%) cases suffered from injuries of the right and left colon, respectively. The majority (91.6%) had undergone primary surgical treatment in field hospitals before being dispatched to our hospital for convalescence and continuation of therapy. Our study indicates that in the presence of identical side-conditions and regardless of anatomical sites, both right and left colon injury can be treated similarly with no significant differences between the two groups (p=0.804). The peculiarities relating to each case demanded a particular surgical therapy. As compared with the results obtained from other surgical therapies the best surgical management of war-associated colonic injuries with the least sequelae is exteriorization (p=0.0000002) which is of first priority, whereas resection of the damaged segment accompanied by colostomy or ileostomy is of second preference. The use of antibiotics in the early phases of colonic injury is mandatory and a rapid diagnosis followed by expedient surgical therapy is of fundamental importance. Therefore, the most effective and convenient process for immediate treatment of wartime injuries is the establishment of reliable and equipped centers in the vicinity of battle zones.