ANALYSIS OF POSTOPERATIVE COMPLICATIONS AND MORTALITY IN GUNSHOT FRAGMENTATION WOUNDS WITH COLON DAMAGE

Abstract. Introduction. Penetrating gunshot wounds of the abdominal cavity in the conditions of war in Ukraine are an urgent problem of military medicine. Gunshot wounds of the colon are observed in 15.0-23.2% of abdominal wounds and are one of the most unfavorable abdominal injuries characterized by a large number of complications and mortality. Aim of the study is to evaluate the results of surgical treatment of wounded with colon injury. Materials and methods. The study is based on a retrospective analysis of the results of treatment of 42 wounded with gunshot shrapnel wounds of the abdominal cavity with colon damage who were treated at the Military Medical Clinical Center of the Northern Region (MMCNR) and the State Institution “Zaitsev Institute of General and Emergency Surgery of the National Academy of Medical Sciences of Ukraine” from 2022 to 2024, aged 25 to 49 years, the average age was 38.8±4.2 years. Damage to the right half of the colon was noted in 20 (47.5%) of the wounded, the left half of the colon in 18 (42.8%), and the rectum in 4 (9.5%). The technique of multistage surgical treatment “Damage control surgery” was used in 12 wounded. Results and Discussion. In the postoperative period, intra-abdominal complications occurred in 21 (50.0%) patients, of which 11 (26.1%) had a combination of two or more complications. Suture failure with peritonitis was noted in 2 (4.7%) cases. In 2 patients, peritonitis occurred against the background of perforation of acute small intestinal ulcers. Relaparotomy, suturing of perforated ulcers with nasogastrointestinal intubation was performed (1 wounded died due to the development of multiple organ failure). On the 4th and 5th postoperative day, 2 wounded were diagnosed with early adhesive small intestinal obstruction by clinical and radiological examination. Relaparotomies, viscerolysis, and nasogastrointestinal intubation were performed. In 2 (4.7%) of the wounded, abdominal abscesses were opened and drained. The development of evolution was observed in 3 wounded in the presence of abdominal compartment syndrome. In the postoperative period, 2 (4.7%) of the wounded died: one on the background of multiple organ failure, which arose as a result of peritonitis due to perforation of acute small intestinal ulcers. In the second case, the presence of evolution against the background of extraperitoneal hematoma, intestinal paresis and abdominal compartment syndrome was complicated by acute renal failure and bilateral pneumonia with a fatal outcome. Conclusions. 1. Gunshot wounds of the abdominal cavity with colon damage remain an urgent problem of military field surgery and require rapid diagnostic and therapeutic actions. 2. High diagnostic accuracy in recognizing colon injuries in abdominal wounds is characteristic of ultrasound according to the FAST protocol and plain radiography of the abdomen (71.4% and 69.0%, respectively), as well as SCT and videocolonoscopy (100%) at the Role 2 stage. However, it should be noted that in one third of the wounded, physical examination and PCI of the wound allow to diagnose colon injuries (28.5% and 40.4%, respectively). 3. When choosing a surgical tactic, it is necessary to take into account the severity of the wounded, the nature of the colon injury, and the prevalence of peritonitis. At the first level of medical care, it is advisable to refuse primary anastomoses of hollow organs. The Damage Control Surgery tactic with programmable laparostomy and reoperation within 72 hours on the principle of “Second look” was used in 12 (28.6%) wounded in serious and extremely serious condition. One (2.3%) wounded died. 4. Gunshot wounds of the colon are accompanied by a high level of complications and disability. Postoperative intra-abdominal complications occurred in 21 (50.0%) wounded, of which 11 (26.1%) cases had a combination of two or more complications. Mortality was 4.7% (2 patients).