Civil gunshot injuries of the rectum - 25 years of experience

Abstract

The first medical literature report for gun shot injuries of the rectum (GIR) appear after the end of the American Civil War. They show a mortality rate of 100%. Our 25 year experience, consisting of 22 cases with GIR is shared. The injuries were from light gun shot weapons and predominantly of criminal character. 12 (54,5%) from the wounded developed shock. The following specific features of GIR have been found out: inner/outer wound in the region above the symphisis - 11 (50,0%); inner/outer wound in the region above the sacrum - 5 (22,7%); inner/outer wound in the region of the perineum - 1 (4,55%); excretion of faeces through the wound - 2 (9,1% ); rectorrhage - 5 (22,7%); blood inrectal touche - 8 (36,4%). 5 (22,7%) intraperitoneal, 13 (59,1%) extraperitoneal supralevatorial and 4 (18,2%) infralevatorial injuries. In addition small intestines have been wounded in 11 (50,0%), urine bladder 8 (36,4%), sigma 4 (18,2%), sacrum 5 (22,7%), urethra 1 (4,55%), anal sphincter 1 (4,55%), aorta 1 (4,55%). The operative interventions for treatment of GIR were: primary suture of the intraperitoneal part (9,1%), primary suture with colostomy 2 (9,1%), Hartmann's operation 7 (31,8%), colostomy with presacral drainage 5 (22,7%), colostomy 7 (31,8%), distal rectal wash out 6 (27,3%). Post operative complications were a result of massive faecal contamination with following severe infection, diffuse peritonitis 18 (81,8%), pelvicphlegmona 7 (31,8%), haemorrhage 3 (13,6%), sepsis 9 (40,1%), necrotic fasciitis 6 (27,3%), pneumonia 8 (36,4%), pulmonary thrombembolism 5 (22,7%). 9 patients died (mortality rate of 40,1%). The most common cause was multiorgan insufficiency 5 (22,7%), followed by pulmonary thrombembolism 3 (13,6%) and severe haemorrhage 1 (4,55%).