title: Indirect colonic injury after military wounding: a case series.
abstract: BACKGROUND
  Colonic trauma in wartime most commonly results from direct injury along the path of a penetrating missile. Rarely, the colon may be injured by primary blast effect or by propagation of energy by the missile, remote from the track of the projectile.
  
  
  RESULTS
  This article describes the clinical presentation and operative findings in five patients who sustained high energy-transfer gunshot wounds (GSWs) or fragmentation injuries from blast who were found to have sustained colonic injuries anatomically remote from the missile track/s.
  
  
  CONCLUSIONS
  Military surgeons should be aware of the phenomenon of indirect injury to the colon after high-energy transfer GSW and blast injury. A high index of suspicion should be maintained and cross-sectional imaging used where feasible. Primary colonic reconstruction was used safely in these patients with indirect colonic injuries.
authors.affiliation: Department of Surgery, Royal Centre for Defence Medicine, Birmingham, United Kingdom.
authors.forename: Claire
authors.initials: C
authors.lastname: Webster
authors.forename: Stuart
authors.initials: S
authors.lastname: Mercer
authors.forename: Jason
authors.initials: J
authors.lastname: Schrager
authors.forename: Thomas W G
authors.initials: TW
authors.lastname: Carrell
authors.forename: Douglas
authors.initials: D
authors.lastname: Bowley
mesh_terms: D000328:Adult; D055826:Afghan Campaign 2001-; D001753:Blast Injuries / Q000175:diagnosis* / Q000601:surgery*; D002648:Child; D003106:Colon / Q000293:injuries* / Q000601:surgery*; D006801:Humans; D008297:Male; D008889:Military Personnel; D016896:Treatment Outcome; D014948:Wounds, Gunshot / Q000175:diagnosis* / Q000601:surgery*