• Claire Webster, Stuart Mercer, Jason Schrager, Thomas W G Carrell, and Douglas Bowley.
• Department of Surgery, Royal Centre for Defence Medicine, Birmingham, United Kingdom.
• J Trauma. 2011 Nov 1;71(5):1475-7.

BackgroundColonic trauma in wartime most commonly results from direct injury along the path of a penetrating missile. Rarely, the colon may be injured by primary blast effect or by propagation of energy by the missile, remote from the track of the projectile.Methods/ResultsThis article describes the clinical presentation and operative findings in five patients who sustained high energy-transfer gunshot wounds (GSWs) or fragmentation injuries from blast who were found to have sustained colonic injuries anatomically remote from the missile track/s.ConclusionsMilitary surgeons should be aware of the phenomenon of indirect injury to the colon after high-energy transfer GSW and blast injury. A high index of suspicion should be maintained and cross-sectional imaging used where feasible. Primary colonic reconstruction was used safely in these patients with indirect colonic injuries.

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