Abstract
Over a period of 14 months between 1990 and 1992, 73 Afghan war wounded with penetrating colon injuries were admitted and treated by a single surgical team in a field hospital of the International Committee of the Red Cross (ICRC). There were 67 males and 6 females with a mean age of 23 years (range 6 to 80 years). Fifty six (77%) patients had multiple associated injuries; admission was delayed longer than 12 hours in 39 (44%); hypotension or deep shock was present at admission in 34 (47%) and 12 (16%) respectively. At laparotomy faecal contamination was limited to one quadrant in 58 (79.5%) cases and major in 15 (20.5%). Fifty-two (71.2%) patients underwent resection and primary anastomosis and 21 (28.8%) primary repair. Exterioristation or diverting colostomy were never used. Four (5.5%) patients died and 11 (15%) had postoperative complications. Overall failure rate was 2.7%, including one faecal fistula conservatively treated and one colostomy raised as a precaution in a patient undergoing relaparotomy for intra-abdominal abscess. No primary repair leaked Deaths were significantly related to delay in admission and age, but not to surgical treatment. One stage primary treatment of large bowel injuries from penetrating abdominal wounds has low mortality, failure and colostomy rates suggesting its wider use regardless of risk factors.
Résumé
Durant une période de 14 mois, entre 1990 et 1992, 73 Afghans avec des blessures de guerre comportant une plaie pénétrante du colon ont été admis et traités par la même équipe chirurgicale dans un hôpital de campagne du Comité International de la Croix Rouge. II avait 67 hommes et 6 femmes d'un âge moyen de 23 ans (6–80 ans). 56 (77%) patients avaient des blessures multiples associées; l'admission fut retardée de plus de 12 heures chez 39 (44%); une hypotension ou un choc profond était présent à l'admission chez 34 (47%) et 12 (16%) respectivement. A la laparotomie, la contamination foecale était limitée à un cadran chez 58 (79.5%) cas et majeurs dans 15 (20.5%). 52 (71.2%) patients subirent une résection avec anastomose primaire et 21 (28.8%) une réparation primaire. L'extériorisation ou la colostomie de décharge ne furent jamais utilisées. 4 (5.5%) patients moururent et 11 (15%) ont eu des complications post-opératoires. Le taux total d'échecs était de 2,7% y compris une fistule fécale traitée de façon conservative et une colostomie effectuée par précaution chez un malade qui a subi une nouvelle laparotomie pour abcès intra-abdominal. Aucune suture primitive n'a fistulisé. Les morts étaient reliés de façon significative au retard dans l'admission et à l'âge mais non au traitement chirurgical. Les taux d'échec, de mortalité et de colostomie sont bas dans le traitement primaire en un temps des plaies du colon au cours des plaies abdominales pénétrantes suggèrant son utilisation plus large en regard des facteurs de risque.
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Strada, G., Raad, L., Belloni, G. et al. Large bowel perforations in war surgery: one-stage treatment in a field hospital. Int J Colorect Dis 8, 213–216 (1993). https://doi.org/10.1007/BF00290309
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DOI: https://doi.org/10.1007/BF00290309