Gunshot bullet trauma of the colon in combat patients injured in hybrid period of Russian-Ukrainian war during 2014-2020

Abstract

Background Gunshot wound to the colon is a frequent injury in armed conflicts. An example of high-energy modern weapon is hollow-point bullets, which is associated with an increased tissue damage and lethal outcome. The aim of this study was to evaluate gunshot injuries to the colon in combat patients and to investigate specific features of the hollow-point and shape-stable bullets features in colon injury. Patients and methods Analyses of clinical data was performed on 384 male soldiers from Armed Forces of Ukraine with gunshot abdominal wound with injury to the colon in East Ukraine between 2014 and 2020. Out of 374 injured, 112 (29.9%)patients were diagnosed with penetrating gunshot bullet wounds: 69/112 (61.6%) were injured by shape-stable bullets and 43/112 (38.4%) patients were injured by the hollow-point bullets. Results More severe hemorrhagic shock stages were in patients injured by hollow-point bullets: shock stages III-IV was in 25 (58.1%) patients injured by the hollow-point bullets vs. 17 (24.6%) patients injured by shape-stable bullets (p=0.0004). Left colon parts were more frequently injured as compared to right colon side or transverse colon in 21 (48.8%) injured by shape-stable (p<0.0001) and in 41 (59.4%) patients injured by the hollow-point bullets (p=0.032). A significant difference was identified for the frequent injury to the middle colon within the entire cohort (p = 0.023). Patients injured with the hollow-point bullets demonstrated a higher frequency of 3-5 areas of colon penetration, which was detected in 18 (41.8%) patients injured by hollow-point bullets and none patients with shape-stable bullets injury (p=0.0001). Colon Injury Scale (CIS) IV was detected in 9 (8%) patients injured by the hollow-point bullets as compared to 7 (10.1%) patients injured by shape-stable bullets (p=0.031). Colostomy was performed in 9 (13%) patients injured by shape-stable bullets and in 8 (19%) patients injured by the hollow-point bullets (p>0.05). 15 (35%) patients died after injury by the hollow-point bullet, whereas 9 (13%) patients after injury 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 outlet wound) and careful revision of the abdomen must be performed to identify possible multiorgan injury as well as multiple perforations of the intestine.