Surgical multidisciplinary approach to a complex war case with urological, colorectal and orthopaedics lesions

We present the case of a 21 years-old male who suffered major multiple injuries as the result of a mine explosion occurred on 19/09/23 in Armenia. They included shrapnel wounds involving the penile urethra, the bladder, the rectum, the anal canal and the upper and lower extremities and multiple fractures of the pelvis. Initially he underwent a stabilizing surgery at the field hospital; he was then transferred to the Astghik Medical Center where a new emergency surgery was performed with the creation of a lateral colostomy and the placement of a midline cystostomy drainage. On 08/10/23, the patient was admitted to the Department of Surgery at Maria Vittoria Hospital in Turin, Italy, with signs of sepsis. Broad-spectrum intravenous antibiotic therapy was promptly initiated. A week later, due to the persistence of the septic state, we performed a surgical abdominal revision consisting of a drainage of multiple intraperitoneal abscesses and resection of the injured rectal tract with conversion of the lateral colostomy into a terminal one, a direct repair of a leakage found in the bladder and a replacement of the cystostomy dreinage. The patient was discharged in good conditions 45 days after surgery. Five months later, the patient underwent a Hartmann's reversal with a Knight-Griffen anastomosis combined with urethral and perineal reconstruction, pubectomy, cystorrhaphy and placement of a new lateral cystostomy. The patient was discharged 45 days after surgery in good clinical conditions. The cystocath and the bladder catheter were removed in outpatient setting two weeks later.