The gun-shot woundings of large bowel as a predictor of severe course of fighting abdominal trauma

Abstract

Objective. Analysis of experience of the medical help delivery to the wounded persons, suffering a gun-shot fighting abdominal trauma and treated in Military–Medical Clinical Centre of Eastern Region, determining a further steps, concerning optimization of the treatment-diagnosis measures in this category of patients. Materials and methods. Medical cards of 27 stationary patients with a gun-shot penetrating woundings of abdominal cavity, who were operated on the first stage in mobile hospitals with further transportation to Military–Medical Clinical Centre of Eastern Region, were studied. Concerning the missile characteristic, causing the wounding, there were 20 fragmentation woundings (іsolated – 2, multiple – 5, combined – 13), the bullet – 7 (іsolated – 1, multiple – 3, combined – 3). There were also 7 thoraco-abdominal woundings, of them 6 – the fragmentation, 1 – the bullet. In 18 patients the treatment consisted of a one-staged operative intervention performance, in 9 of them –in several stages. Among the wounded persons, who needed multi-staged treatment, 77.8% have had the large bowel damage. Results. The reoperations performance, which were more characteristic for the wounded persons with the large bowel damages, was folllowed by morbidity (adhesional ileus, peritonitis, etc.), enhancement in 2.6 times of purulent complications of postoperative wound, and in 2 times – of the average index of stationary stay, what have demanded a proportionally enhanced expenses from the health-care military system. Conclusion. Among the gun-shot penetrating woundings of abdominal cavity the multiple and combined fragmentation woundings prevailed. As a result, a statistically significant association between damages of large bowel and enhancement of prediction for the morbidity development and the treatment duration was established, using the method of correlation-regression analysis. The large bowel woundings constitute a predictor of more severe course of fighting abdominal trauma and development of complications, what leads to necessity for elaboration of differentiated approach to operative treatment of this wounded persons’ category with objective to reduce a stationary stay and possibility of the morbidity development.

Keywords

• gun-shot penetrating abdominal wounding
• large intestine
• colostomy