Should Colon-Penetrating Small Missiles Be Removed? An Experimental Study of Retrocolic Wound Tracks

Abstract

Small-fragment injury to the colon may occur in approximately 5% of battlefield casualties. The surgical management aims to reduce the risk of retrocolic infection and provide optimal conditions for colonic wound healing. This study aimed to quantify the risk of retrocolic infection. Steel fragments were fired through exteriorized porcine colon and caught in 20% gelatin. The fragments, and resultant tracks, were extracted and subjected to quantitative bacteriological examination to determine the extent of contamination. The median bacterial count for complete tracks was 1.2 104 CFU/g (interquartile range 1.8 103 to 2.7 104). Counts were highest in the initial 1 cm of the track and reduced along its length. This study does not support wound track excision or missile fragment removal in cases of retrocolic trauma following penetrating colonic injury. Either or both procedures will increase local trauma and are likely to prejudice colonic wound repair.

• Antipersonnel Fragment Colonic Trauma Military Retrocolic Infection