[Complications after primary surgical management of war injuries of the colon and rectum].

War injuries of colon and rectum are real challenge for war surgeons. The aim of the study was to point out the necessity of war surgical doctrine application, considering the risk factors in the choice of primary surgical procedure and surgeon's experience in managing this kind of injuries. Postoperative complications and indications for reoperations in 216 wounded after primary surgical management of colonic and rectal war injuries in the period 1991-1995 were retrospectively analyzed. A total of 183 wounded (84.7%) were primarily surgically managed in war hospitals. Combined injuries of colon and/or rectum or more than 2 abdominal organs were found in 197 wounded (91.2%), and 29.1% of wounded were also with the combined extra-abdominal injuries. Postoperative complications were observed in 58 wounded (26.8%) and were associated with the injury and primary management of colon and rectum, with septic complications in 87.9% of cases. Reoperation was performed in 44 wounded (75.8%) and the most frequent indications, such as diffuse peritonitis and stercoral fistula, were the sequlae of dehiscence of suture or anastomosis, overlooked lesions and secondary perforations (blast) of colon or rectum. Principle of complete diversion of stool/intestinal content was used in reoperation. Mortality rate in reoperated group was 20.4% (9 wounded). Cause of death was diffuse peritonitis followed by consecutive sepsis and MOFS. The significance of surgical war doctrine and risk factors in the choice of primary surgical procedures were emphasized.