2023 Global Health Engagement and Humanitarian Surgery Presentations

MSS11: GUNSHOT COLON INJURIES - "TERRA INCOGNITA" IN THE DIAGNOSIS OF COMBAT ABDOMINAL TRAUMA. EXPERIENCE OF WAR IN UKRAINE.
Kostiantyn Gumeniuk, COL, MD, PhD, Assoc Prof1; Oksana Popova, MD, PhD Student2; 1Medical Forces Command of Ukrainian Armed Forces, Ukrainian Military Medical Academy - Kiyv, Ukraine; 2Military Medical Clinical Center of the Eastern Region, NGO ELLING Training Center - Dnipro, Ukraine

Objectives: Combat penetrating abdominal trauma(PAT) with colon injuries(CI) are accompanied with high mortality and complications rate. The main diagnostic problems that arise in this situation are:

1. Lack of early sensitive signs that would allow to detect CI timely.

2. Complicated intraoperative diagnosis for small lesions, when they are located in the retroperitoneal part, in the presence of blood or contamination of the abdominal cavity.

Methods: 421 cases of injuried servicemen with PAT and CI during of war in Ukraine were analyzed. The main measures taken to improve care for the wounded were:

1. Rapid ultrasound colon assessment.

2. Intraoperative colonoscopy(IOC) in case of suspected colon damage or inability to verify the number of colon injuries.

Results: On Role 2 the ultrasound examination has performed. In 349 (82.9%) cases from 421, e-FAST was positive mainly due to injury of other organs (spleen, liver, kidneys, small intestine). In 72 cases e-FAST was negative, additional ultrasound colon assessment made it possible to detect CI in 65 cases.

Also at the Role 2, 26 IOCs were performed for combat PAT, which in 19 cases allowed clear and quickly verify CI and establish the anatomical location. In 7 cases, IOC allowed to exclude CI.

Number of CI increased from 7% (2014-2015) to 13.3% (2021-2022) and to some extent this is due to improved diagnostic approaches. The number of operations in first 24h for CI increased from 91.7% (66 from 72 in 2014-2015) to 99.5% (211 from 212 in 2021-2022). Mortality in this category of patients decreased from 13.04% to 6.29% (p-value<0.05). The total number of complications from 36.96% to 17% (p-value<0.05).

Conclusions:

1. Preoperative diagnosis of CI for combat PAT is a difficult problem, the solution of which can significantly affect mortality and complications among such injuried.

2. E-FAST is an important and useful option, which has already proven its effectiveness, which, however, is not sufficient for a full preoperative assessment of combat PAT at the Role 2 and needs to be refined to take into account the need to detect CI.

3. IOC performing in the conditions of Role 2 is a useful option that greatly facilitates the diagnosis of small injuries and significantly improves the treatment results for patients with CI.

4. The implementation of these measures to daily routine at the Role 2 allowed to improve the quality of care for this category of wounded, reduce rate of complications and mortality.