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. 2023 Jan 27;23(1):23.
doi: 10.1186/s12893-023-01919-6.

Gunshot injury to the colon by expanding bullets in combat patients wounded in hybrid period of the Russian-Ukrainian war during 2014-2020

Kostiantyn Gumeniuk  1   2 , Igor A Lurin  3   4 , Ievgen Tsema  5 , Lesia Malynovska  5 , Maksym Gorobeiko  6 , Andrii Dinets  7
Affiliations

Gunshot injury to the colon by expanding bullets in combat patients wounded in hybrid period of the Russian-Ukrainian war during 2014-2020

Kostiantyn Gumeniuk et al. BMC Surg. .

Abstract

Background: A gunshot wound to the colon is a frequent injury in armed conflicts. An example of a high-energy modern weapon is hollow-point bullets, which is associated with increased tissue damage and lethal outcome. The aim of this study was to evaluate gunshot injuries to the colon in combat patients and to assess the difference in clinical features of patients with colon injuries by hollow-point versus shape-stable bullets.

Patients and methods: Analyses of clinical data were performed on 374 male soldiers from the Armed Forces of Ukraine with gunshot abdominal wounds with injury to the colon in East Ukraine between 2014 and 2020. Out of 374 injured, 112 (29.9%) patients were diagnosed with penetrating gunshot bullet wounds: 69/112 (61.6%) were injured by shape-stable bullets, and the hollow-point bullets injured 43/112 (38.4%) patients.

Results: More severe hemorrhagic shock stages were in patients injured by hollow-point bullets: shock stages III-IV was in 25 (58.1%) patients injured by the hollow-point bullets vs. 17 (24.6%) patients injured by shape-stable bullets (p = 0.0004). Left colon parts were more frequently injured as compared to the right colon side or transverse colon: 21 (48.8%) patients were injured by the hollow-point bullets (p < 0.0001), and 41 (59.4%) patients were injured by the shape-stable bullets (p = 0.032). A significant difference was identified for the frequent injury to the middle colon within the entire cohort (p = 0.023). Patients injured by the hollow-point bullets demonstrated a higher frequency of 3-5 areas of colon gunshot defects, which was detected in 18 (41.8%) patients injured by hollow-point bullets and none with shape-stable bullets injury (p = 0.0001). Colon Injury Scale (CIS) IV was detected in 7 (16.3%) patients injured by the hollow-point bullets as compared to 2 (2.9%) patients injured by shape-stable bullets (p = 0.011). Colostomy was performed in 14 (69%) patients injured by shape-stable bullets and in 12 (27.9%) patients injured by hollow-point bullets (p > 0.05). 15 (35%) patients died after injury by the hollow-point bullet, whereas 9 (13%) patients after damage by the shape-stable bullets (p = 0.0089).

Conclusions: All patients should be suspected to have an injury by bullet with expanding properties in case of penetrating abdominal injury (absent of outlet wound) and careful revision of the abdomen must be performed to identify possible multiorgan injury as well as multiple gunshot defects of the intestine.

Keywords: Colon injury; Expanding bullet; Gunshot; Hollow-point bullet; Shape-stable bullets; War in Ukraine.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Schematic illustration of gunshot injury to the various parts of the colon of study cohort
Fig. 2
Fig. 2
Intraoperative photograph of colon gunshot injury. A A single wound to the colon (entry gunshot hole marked with an arrow). B Multiple injuries to the colon by fragments of bullet (marked with arrows)
Fig. 3
Fig. 3
Photographs of X-ray films illustrating intraabdominal fragments with metal density features
Fig. 4
Fig. 4
Intraoperative photograph demonstrating hollow-point bullet with mushrooming effect (a yellowish metal object in the arms of the surgeon)
See this image and copyright information in PMC

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