First experience of laparoscopic colon resection with primary anastomosis for combat-related thoracoabdominal trauma with through-and-through colon injury

Abstract

Aim: to demonstrate the possibilities and advantages of laparoscopic surgery in combat-related abdominal penetrating trauma with colon injury.

Materials and methods. This case report presents the first experience of laparoscopic colon resection with primary anastomosis for combat-related thoracoabdominal trauma with through-and-through colon injury. A 47-year-old serviceman sustained an explosive penetrating thoracoabdominal injury (dropping explosives from a drone) operated 10 hours after. Initial management at Role 2 included chest tube drainage, surgical debridement, and wound sealing of the chest. CT: penetrating gunshot wound with internal and external damage to the lower lobe of the left lung, perforation of the diaphragm on the left, and transverse colon perforation with a retained metal fragment, pneumoperitoneum, drained hemopneumothorax, and a gunshot fracture of the posterior third of the 5^th left rib. Exploratory laparoscopy revealed no free fluid in the abdominal cavity. Surgery: the diaphragmatic perforation was sutured with a 3-0 V-loc barbed suture, the segment of the transverse colon was resected using two Endo-GIA 60 linear staplers according to the severity of injury (AAST Grade 3) and non-viable edges of colon wound. To ensure mobility, a side-to-side antiperistaltic anastomosis was performed using an Endo-GIA 60 stapler (blue cartridge). The anastomosis site was reinforced with a single-layer 3-0 V-loc suture. The procedure was completed with abdominal drainage and port site closure.

Results. Postoperative recovery was without complications. The abdominal drain was removed on the 2^nd day, and the pleural drain on the 5^th day after the control CT scan. Follow-up after 1.5 month – returned to military service. Our case demonstrates that laparoscopic surgery can be a useful option for combat-related colon injuries when tissue damage is minimal and the patient’s condition is stable. The absence of massive hemoperitoneum and contamination confirms the feasibility of primary repair or anastomosis.

Conclusions. Laparoscopic surgery for combat-related penetrating abdominal trauma with colon injuries is feasible and safe in stable patients. If there are no multiple colon injuries or significant contamination, primary repair or stapled anastomosis is a suitable option.