2023 Military Poster Presentations

MSSP576: GUNSHOT INJURY TO THE COLON IN RELATION TO WOUND BALLISTIC: AN EXPERIENCE FROM COMBAT TRAUMA IN UKRAINE
Vitaliy Tsymbaliuk, MD, PhD, Professor1; Kostiantyn Gumeniuk, MD, PhD2; Igor Lurin, MD, PhD, Professor1; Oleksandr Usenko, MD, PhD, Professor3; Andrii Dinets, MD, PhD4; 1National Academy of Medical Sciences of Ukraine, Kyiv, Ukraine; 2Armed Forces Medical Command, Ministry of Defence of Ukraine, Kyiv, Ukraine; 3Shalimov National Institute of Surgery and Transplantation, Kyiv, Ukraine; 4Department of Surgery, Institute of Biology and Medicine, Taras Shevchenko National University of Kyiv, Kyiv, Ukraine

Objectives: Gunshot wound to the colon is a frequent in armed conflicts.

The aim of this study was to investigate and evaluate injury to the colon in combat patients as well as to determine specific features of the hollow-point bullet in transient structure simulations and animal models.

Methods: Clinical analyses were performed on 112 male soldiers from Armed Forces of Ukraine with gunshot injury to the colon, wounded in East Ukraine between 2014 and 2020. Animal model constituted 20 pigs, and ANSYS AUTODYN software was used for the simulation of the wound ballistics for 5.45mm V-max hollow-point bullets.

Results: 43 (38.4%) patients were injured by the hollow-point bullets and 69 (61.6%) patients by shape-stable bullets. Shock stages III-IV were in 25 (58.1%) patients injured by the hollow-point vs. 17 (24.6%) patients injured by shape-stable bullets (p=0.0004). 18 (41.8%) patients injured by hollow-point bullets demonstrated 3-5 areas of colon penetration vs. none with shape-stable bullets injury (p=0.0001). Colon Injury Scale IV was detected in 9 (8%) patients injured by the hollow-point bullets vs. 7 (10.1%) patients by shape-stable bullets (p=0.031). 15 (35%) patients died after injury by the hollow-point bullet vs. 9 (13%) injured by the shape-stable bullets (p=0.0089).

Conclusions: All patients should be suspected to have a hollow-point injury in case of penetrating injury (absent exit wound) and careful revision of the abdomen must be performed to identify possible multiorgan injury as well as multiple perforations of the intestine.