Safety of Primary Repair in Penetrating Colorectal Injuries during Current Yemeni War

Abstract

Aims: This study aimed to evaluate the septic colon related-complications and death after primary repair (PR) of penetrating colon injuries (PCIs). Study Design:  Retrospective observational study. Place and Duration of Study: This study was conducted at the Department of Surgery, of the field hospital in the Yemeni city; Taiz. Patients' files were reviewed from April 2015 to January 2020 during the current Yemeni Civilian war. Methodology: We included 56 consecutive PCI patients exclusively managed with PR (55 men, 1 woman; age range 14-60 years). All cases were secondary to ballistic mechanism of injury (MOI), mostly gunshot wound (GSW), with no one stab wound (SW). Forty-two cases underwent PR solely by enterorrhaphy, and 14 cases required at least one primary anastomosis (PA) for their PR. A total of 64 colon wounds were managed within 24 hours by PR (whether enterorrhaphy for non-destructive PCIs [50 of 64] or PA for destructive injuries [14 of 64]). Results: Nineteen patients (33.9%) developed 30 colon-related infectious complications. No one died as a result of colon injury. Incisional surgical site infection (SSI) was the most common complication, occurring in 17.9% of cases, followed by missile-tract wound infection in 16.1%. Relatively less common complications were enterocutaneous fistula with a rate of 10.7%, in addition to a rate of 5.4% for intra-abdominal abscess and 3.6% for fascial dehiscence. Remarkably, no one patient suffered from major suture-line failure with peritonitis. Only seven patients required re-operation for these complications:  three enterocutaneous fistula cases required diversion stoma, two cases required debridement for wound infection, and two cases required closure of abdominal wall after fascial dehiscence. Conclusion: Apart from wound infections, the one-stage PR procedure can be an acceptable option for PCIs in the resource-limited settings of battlefields. Further research is needed to determine absolute contraindications to PR to avoid stoma complications.