Surgical treatment of ano-rectal gunshot injuries caused by low-velocity bullets

BACKGROUND: The aim of the study was to evaluate the results of treatment for ano-rectal gunshot injuries in civilian population, caused by low-velocity bullets. METHODS: Nine patients with ano-rectal gunshot injuries were admitted to the emergency department. All the patients were males, with a mean age of 23 years (range 20 to 37 years) and presented within the first two hours following injury. Complete physical and abdominal examinations were performed and injury severity scores (ISS) were calculated. Injuries were evaluated by rectosigmoidoscopy in the operating room. Seven patients had associated tissue or organ injuries including bladder disruption, pelvic bone fractures, and wide muscular defects. Surgical procedures included a diverting ostomy, irrigation of distal rectum, presacral drainage (6 patients), and retrorectal drainage through the abdomen (3 patients). Antibiotic prophylaxis was routinely administered. Control examinations were made at the end of the second month. RESULTS: Seven patients had rectal blood discharge on admission. The mean ISS score was 7.3±3.7, with only one patient having an ISS of 15. Early postoperative complications were urinary infection in three patients, wound dehiscence in five patients, and osteomyelitis in one patient. Anal continence was not adversely influenced after surgery. CONCLUSION: Our results suggest that a diverting ostomy, distal rectal irrigation, and presacral drainage yields favorable outcome in patients with ano-rectal gunshot injuries.