Gunshot injury to the colon by expanding bullets in combat patients wounded in hybrid period of the Russian-Ukrainian war during 2014–2020
Abstract Background A gunshot wound to the colon is a frequent injury in armed conflicts. An example of a high-energy modern weapon is hollow-point bullets, which is associated with increased tissue damage and lethal outcome. The aim of this study was to evaluate gunshot injuries to the colon in com...
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| Format: | Article |
| Language: | English |
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BMC
2023-01-01
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| Series: | BMC Surgery |
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| Online Access: | https://doi.org/10.1186/s12893-023-01919-6 |
| _version_ | 1811176039080001536 |
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| author | Kostiantyn Gumeniuk Igor A. Lurin Ievgen Tsema Lesia Malynovska Maksym Gorobeiko Andrii Dinets |
| author_facet | Kostiantyn Gumeniuk Igor A. Lurin Ievgen Tsema Lesia Malynovska Maksym Gorobeiko Andrii Dinets |
| author_sort | Kostiantyn Gumeniuk |
| collection | DOAJ |
| description | Abstract Background A gunshot wound to the colon is a frequent injury in armed conflicts. An example of a high-energy modern weapon is hollow-point bullets, which is associated with increased tissue damage and lethal outcome. The aim of this study was to evaluate gunshot injuries to the colon in combat patients and to assess the difference in clinical features of patients with colon injuries by hollow-point versus shape-stable bullets. Patients and methods Analyses of clinical data were performed on 374 male soldiers from the Armed Forces of Ukraine with gunshot abdominal wounds 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 the hollow-point bullets injured 43/112 (38.4%) patients. 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 the right colon side or transverse colon: 21 (48.8%) patients were injured by the hollow-point bullets (p < 0.0001), and 41 (59.4%) patients were injured by the shape-stable 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 by the hollow-point bullets demonstrated a higher frequency of 3–5 areas of colon gunshot defects, which was detected in 18 (41.8%) patients injured by hollow-point bullets and none with shape-stable bullets injury (p = 0.0001). Colon Injury Scale (CIS) IV was detected in 7 (16.3%) patients injured by the hollow-point bullets as compared to 2 (2.9%) patients injured by shape-stable bullets (p = 0.011). Colostomy was performed in 14 (69%) patients injured by shape-stable bullets and in 12 (27.9%) patients injured by hollow-point bullets (p > 0.05). 15 (35%) patients died after injury by the hollow-point bullet, whereas 9 (13%) patients after damage by the shape-stable bullets (p = 0.0089). Conclusions All patients should be suspected to have an injury by bullet with expanding properties in case of penetrating abdominal injury (absent of outlet wound) and careful revision of the abdomen must be performed to identify possible multiorgan injury as well as multiple gunshot defects of the intestine. |
| first_indexed | 2024-04-10T19:45:35Z |
| format | Article |
| id | doaj.art-b9983427480a49679dd3e5dca7eee45e |
| institution | Directory Open Access Journal |
| issn | 1471-2482 |
| language | English |
| last_indexed | 2024-04-10T19:45:35Z |
| publishDate | 2023-01-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Surgery |
| spelling | doaj.art-b9983427480a49679dd3e5dca7eee45e2023-01-29T12:03:16ZengBMCBMC Surgery1471-24822023-01-012311910.1186/s12893-023-01919-6Gunshot injury to the colon by expanding bullets in combat patients wounded in hybrid period of the Russian-Ukrainian war during 2014–2020Kostiantyn Gumeniuk0Igor A. Lurin1Ievgen Tsema2Lesia Malynovska3Maksym Gorobeiko4Andrii Dinets5Medical Forces Command, Armed Forces of UkraineNational Academy of Medical Sciences of UkraineDepartment of Surgery, Bogomolets National Medical UniversityDepartment of Surgery, Bogomolets National Medical UniversityDepartment of Surgery, Institute of Biology and Medicine, Taras Shevchenko National University of KyivDepartment of Surgery, Institute of Biology and Medicine, Taras Shevchenko National University of KyivAbstract Background A gunshot wound to the colon is a frequent injury in armed conflicts. An example of a high-energy modern weapon is hollow-point bullets, which is associated with increased tissue damage and lethal outcome. The aim of this study was to evaluate gunshot injuries to the colon in combat patients and to assess the difference in clinical features of patients with colon injuries by hollow-point versus shape-stable bullets. Patients and methods Analyses of clinical data were performed on 374 male soldiers from the Armed Forces of Ukraine with gunshot abdominal wounds 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 the hollow-point bullets injured 43/112 (38.4%) patients. 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 the right colon side or transverse colon: 21 (48.8%) patients were injured by the hollow-point bullets (p < 0.0001), and 41 (59.4%) patients were injured by the shape-stable 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 by the hollow-point bullets demonstrated a higher frequency of 3–5 areas of colon gunshot defects, which was detected in 18 (41.8%) patients injured by hollow-point bullets and none with shape-stable bullets injury (p = 0.0001). Colon Injury Scale (CIS) IV was detected in 7 (16.3%) patients injured by the hollow-point bullets as compared to 2 (2.9%) patients injured by shape-stable bullets (p = 0.011). Colostomy was performed in 14 (69%) patients injured by shape-stable bullets and in 12 (27.9%) patients injured by hollow-point bullets (p > 0.05). 15 (35%) patients died after injury by the hollow-point bullet, whereas 9 (13%) patients after damage by the shape-stable bullets (p = 0.0089). Conclusions All patients should be suspected to have an injury by bullet with expanding properties in case of penetrating abdominal injury (absent of outlet wound) and careful revision of the abdomen must be performed to identify possible multiorgan injury as well as multiple gunshot defects of the intestine.https://doi.org/10.1186/s12893-023-01919-6Colon injuryGunshotWar in UkraineShape-stable bulletsHollow-point bulletExpanding bullet |
| spellingShingle | Kostiantyn Gumeniuk Igor A. Lurin Ievgen Tsema Lesia Malynovska Maksym Gorobeiko Andrii Dinets Gunshot injury to the colon by expanding bullets in combat patients wounded in hybrid period of the Russian-Ukrainian war during 2014–2020 BMC Surgery Colon injury Gunshot War in Ukraine Shape-stable bullets Hollow-point bullet Expanding bullet |
| title | Gunshot injury to the colon by expanding bullets in combat patients wounded in hybrid period of the Russian-Ukrainian war during 2014–2020 |
| title_full | Gunshot injury to the colon by expanding bullets in combat patients wounded in hybrid period of the Russian-Ukrainian war during 2014–2020 |
| title_fullStr | Gunshot injury to the colon by expanding bullets in combat patients wounded in hybrid period of the Russian-Ukrainian war during 2014–2020 |
| title_full_unstemmed | Gunshot injury to the colon by expanding bullets in combat patients wounded in hybrid period of the Russian-Ukrainian war during 2014–2020 |
| title_short | Gunshot injury to the colon by expanding bullets in combat patients wounded in hybrid period of the Russian-Ukrainian war during 2014–2020 |
| title_sort | gunshot injury to the colon by expanding bullets in combat patients wounded in hybrid period of the russian ukrainian war during 2014 2020 |
| topic | Colon injury Gunshot War in Ukraine Shape-stable bullets Hollow-point bullet Expanding bullet |
| url | https://doi.org/10.1186/s12893-023-01919-6 |
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