title: Management of colorectal injuries during operation iraqi freedom: patterns of stoma usage.
abstract: BACKGROUND
  Management of penetrating colorectal injuries in the civilian trauma population has evolved away from diversionary stoma into primary repair or resection and primary anastomosis. With this in mind, we evaluated how injuries to the colon and rectum were managed in the ongoing war in Iraq.
  
  
  METHODS
  The records of Operation Iraqi Freedom patients evacuated to National Naval Medical Center (NNMC) from March 2004 until November 2005 were retrospectively reviewed. Patients with colorectal injuries were identified and characterized by the following: (1) injury type; (2) mechanism; (3) associated injuries; (4) Injury Severity Score; (5) levels of medical care involved in patient treatment; (6) time interval(s) between levels of care; (7) management; and (8) outcomes.
  
  
  RESULTS
  Twenty-three patients were identified as having either colon or rectal injury. The average ISS was 24.4 (range, 9-54; median 24). On average, patients were evaluated and treated at 2.5 levels of surgically capable medical care (range, 2-3; median 2) between time of injury and arrival at NNMC, with a median of 6 days from initial injury until presentation at NNMC (range, 3-11). Management of colorectal injuries included 7 primary repairs (30.4%), 3 resections with anastomoses (13.0%), and 13 colostomies (56.6%). There was one death (4.3%) and three anastomotic leaks (30%). Total complication rate was 48%.
  
  
  CONCLUSIONS
  Based upon injury severity, the complex nature of triage and medical evacuation, and the multiple levels of care involved for injured military personnel, temporary stoma usage should play a greater role in military casualties than in the civilian environment for penetrating colorectal injuries.
authors.affiliation: Department of Surgery, National Naval Medical Center, Bethesda, Maryland, USA. drjduncan@hotmail.com
authors.forename: James E
authors.initials: JE
authors.lastname: Duncan
authors.forename: Christian H
authors.initials: CH
authors.lastname: Corwin
authors.forename: W Brian
authors.initials: WB
authors.lastname: Sweeney
authors.forename: James R
authors.initials: JR
authors.lastname: Dunne
authors.forename: John W
authors.initials: JW
authors.lastname: Denobile
authors.forename: Philip W
authors.initials: PW
authors.lastname: Perdue
authors.forename: Michael R
authors.initials: MR
authors.lastname: Galarneau
authors.forename: Jonathan P
authors.initials: JP
authors.lastname: Pearl
mesh_terms: D000328:Adult; D000714:Anastomosis, Surgical; D015331:Cohort Studies; D003082:Colectomy / Q000009:adverse effects / Q000379:methods*; D003106:Colon / Q000293:injuries*; D003107:Colorectal Surgery / Q000379:methods; D003125:Colostomy / Q000379:methods / Q000706:statistics & numerical data; D005500:Follow-Up Studies; D006772:Hospitals, Military; D006801:Humans; D015994:Incidence; D015601:Injury Severity Score; D007493:Iraq; D008297:Male; D011183:Postoperative Complications / Q000453:epidemiology; D012007:Rectum / Q000293:injuries; D012189:Retrospective Studies; D018570:Risk Assessment; D054047:Surgical Stomas / Q000706:statistics & numerical data*; D015996:Survival Rate; D016896:Treatment Outcome; D014857:Warfare; D014950:Wounds, Penetrating / Q000401:mortality / Q000601:surgery*