A Review of 100 Cases of Colonic Injuries Admitted to Baghdad Teaching Hospital According to ACS Grading System


ABSTRACT:BACKGROUND:In Iraq nearly 95% of colonic injuries are caused by penetrating trauma (gun shot, blast injuries, stab injuries, or iatrogenic trauma), blunt injuries are rare & commonly result from road traffic accidents or fall from height. While in the rest of the world, penetrating trauma accounts for 80-90% of cases. This higher rate of penetrating trauma in Iraq is due to the high rate of terrorism attacks with low & high velocity missiles.OBJECTIVE:The aim is to study cases with colonic injuries according to ACS(American College of Surgeons) grading system, the surgical management applied & the postoperative outcome of each grade.PATIENTS AND METHODS:This prospective study comprises (100) patients with documented colonic injuries admitted to the surgical wards at Baghdad Teaching Hospital spanning the years 2006 to 2008.The parameters used in this study include: age, gender, mechanism of injury, part of the colon involved by injury, the grade of the injury, other associated organ injuries, the method chosen to manage the injury & the outcome (uneventful recovery, postoperative morbidity & death).RESULTS:Colonic injuries were caused by bullet injuries in 50% of cases, sigmoid colon was the most common involved part (32%), 64% of cases were of grade 2 ACS , the most common associated organ injury was small intestine (60%),colonic injuries were primarily sutured in 48% of cases, while other 48% of cases ended with colostomy. Morbidity postoperatively were recorded in 32% of cases, most frequently with grade 2 & in cases treated by colostomy. Postoperative Death was recorded in 14 % of cases.CONCLUSION:According to our study, ACS grading system proves to be highly beneficial to be applied in the coarse of management of colonic injuries.