Colon diversion versus primary colonic repair in gunshot abdomen with penetrating colon injury in Libyan revolution conflict 2011 (a single center experience)

Int J Colorectal Dis. 2014 Sep;29(9):1137-42. doi: 10.1007/s00384-014-1918-7. Epub 2014 Jun 11.


Purpose: The objective of this study is comparing colon diversion versus primary repair in penetrating colon gunshot injuries.

Methods: A retrospective study of 63 cases of gunshot abdomen with penetrating colon injury were admitted to Al-jalla Hospital in 2011 in Benghazi, Libya. After surgical intervention, these patients were observed for any postoperative complications.

Results: During the study period, 63 eligible patients included, 62 (98.4%) were males and 1 (1.6%) was female. And the mean age was 29.24 years. Eighteen patients had an injury on the right side of the colon, while 16, 6, 11, 6, 2, 3, and 1 patients had an injury on the transverse, left, sigmoid, rectum, right transverse, left transverse, and total colonic injury, respectively. In the first group, 23 patients (36.5%) was treated with colon diversion, (2 with Hartmann's operation, 21 with loop colostomy). In the second group, 40 patients (63.4 %) was treated with primary repair. Eighteen (28.5%) with right hemicolectomy, 5 (7.9%) with transverse colon resection and anastomosis, and 17 (26.9%) with simple repair. We evaluate the rate of postoperative complication and compare the postoperative morbidity between both groups.

Conclusion: In our study, there was no significant statistical difference between types of operations and rate of complications (P = 0.18). We could not see any advantage of the diversion over the primary repair. To reduce risk of the psychological trauma, complications of colostomy, unnecessary repeated hospitalization, decrease of economic cost, and complications of stoma revision operation, we should consider that the primary repair of penetrating colon injuries is an acceptable alternative method of treatment over the colostomy.

MeSH terms

  • Adolescent
  • Adult
  • Anastomosis, Surgical / adverse effects
  • Colectomy / adverse effects
  • Colon / injuries*
  • Colon / surgery*
  • Colostomy* / adverse effects
  • Colostomy* / psychology
  • Female
  • Humans
  • Libya
  • Male
  • Middle Aged
  • Rectum / injuries
  • Rectum / surgery
  • Reoperation
  • Retrospective Studies
  • Treatment Outcome
  • Warfare
  • Wound Healing
  • Wounds, Gunshot / surgery*
  • Young Adult