The Safety of Primary Repair in Penetrating Colorectal Injuries During Current Yemeni War

Abstract

 The study evaluated the surgical outcomes of a 4-year experience with war-related penetrating colorectal injuries
(PCIs) at a field hospital in Taiz city during the current Yemeni Civilian War. Where the management policy had favored primary
repair (PR) of colorectal injuries. Patients and methods: The purpose of this retrospective study was to evaluate septic colon
related-complications and death in a series of 56 consecutive PCI patients exclusively managed with PR at the field hospital of
Taiz, Yemen. Patients records and files were reviewed for the duration from April 2015 to January 2020 of the current Yemeni
Civilian war. Results: As 8 patients had multiple-PCIs, the whole 56 patients inflicted a total of 64 colon injures were managed by
PR within 24 hours (42 cases underwent PR by primary suture/s and 14 cases required at least resection and anastomosis [PA] for
their PR). All cases were secondary to ballistic mechanism of injury (MOI), most commonly from gunshot wound (GSW), with no
one stab wound (SW). Nineteen patients (33.9%) developed 30 colon-related infectious complications. No one death was related to
colon injury PR. The most common complications were incisional surgical site infection (SSI) that occurred in 17.9% of cases (10
of 56), followed by missile-track wound infection in 16.1 % (9 of 56). Relatively less common complications were
enterocutaneous fistula in 10.7% (6 of 56), in addition to a rate of 5.4% (3 of 56) for intra-abdominal abscess and 3.6% (2 of 56)
for fascial dehiscence. Remarkably, no one patient suffered from suture-line failure and peritonitis. Only 7 patients were reoperated:
3 enterocutaneous fistula cases required diversion stoma, 2 cases required debridement for wound infection, 2 cases
required the closure of abdominal wall after fascial dehiscence. Conclusion: The one-stage PR procedure is safe and effective
management for PCIs in the limited resource setting of battlefields