The major public health problem in many countries is trauma. Traumas are of two types that is blunt trauma and penetrating trauma. Both military and civilian face penetrating wound. These kind of injuries are life threatening but rate of death has been reduced over the time period and improvement in medical practice(2). The most common organ which is injured in worldwide is gut(3, 4). In penetrating abdominal trauma colon is the second most commonly injured organ after small bowel. On contrary, blunt trauma causing colon injuries is rare and happens in 2-5% of victims(5).

Around 60-90% of injuries to gut are due to Gunshot and up to 30% colonic injuries are result of stabbing(6). Because of elevation in violence, robberies, interpersonal and communal clashes and domestic violence, Pakistan is at high risk in abdominal injuries.  Colon is more prone to get injured because of its size and anatomical position(7).

During the last century, the management of gut injury has evolved(8). The surgeons in practice in battle field of World War-II gained a lot of experience in abdominal injuries and put that understanding in civilian practice(9).

 Gut  injuries are usually not isolated. Hence there are not specific sign and symptoms(10). The early development of inflammation of peritonitis with free gas radiology evidence in the peritoneum is the early sign of  colon injuries(11). Diagnosis of intestinal injuries is often delayed. These injuries require immediate recognition to reduce the rate of death from the loss of blood and contamination of feces  (12). First primary effort should be done to decrease hypothermia, hypotension, shock and acidosis, all of these can increase the rate of mortality and morbidity. Next step should be to take sample and to assess any small gut and colorectal injuries(13).

There is no regional score between senior surgeons exists for the repair of  gut injuries by extra mucosal repair without covering stoma (14). Therefore it is realized that extra mucosal should be adopted in our hospital setups without covering stoma  if they present in golden hour after trauma because of very minimal contamination(15). As the studies show that the healing with extra mucosal  without covering stoma has less complications in terms of wound infection and intra-abdominal collection presented early in the course of their management  then it will be adopted by senior surgeons in hospital setups as method of choice in managing of traumatic gut injuries.

Fraser showed the use of extra mucosal technique for intestinal anastomosis in three patients with inflammation of peritonitis, however there are no experimental studies of its use in the presence of peritonitis(2).

Inclusion Criteria:

 Both genders were included from age 15 to 50 years. Patients who came to emergency department with single or multiple penetrating injuries to abdominal either y gunshot or stab or last pellet were all included in this study.

Exclusion Criteria :

Patients who had already existing chronic illness for example diabetes, tuberculosis, jaundice and chronic renal disease was excluded. Moreover patients coming to emergency department with penetrating abdominal trauma who also had associated injuries to chest, head and neck were excluded

It was a prospective study which was conducted in DHQ Teaching Hospital KDA Kohat, from July 2022 to December 2022.  During the period of study 265 patients were reported in emergency department. Patients who met the inclusive criteria of abdominal penetrating injuries were preferred in this study. Patients were thoroughly examined by the staff on duty. In emergency department the ATLS protocol was strictly followed and patients were resuscitated and stabilized. After that detailed examination from head to toe was done. After this patients was again re-evaluated by senior surgeon who took the final decision to operate.

In operation theater, nasogastric tube and Foley`s catheter were passed. After giving general anesthesia, the endotracheal tube was passed. Third generation cephalosporin 1gm and Metronidazole 0.5 gm were given at the time of induction. Patient was adjusted in a supine lying position. Full length midline incision was made from xiphisternum to pubic symphysis. After identification of injured part, non-crushing intestinal clamps were applied to control soiled fecal matter. After securing hemostasis, gut  was repair in single layer extra mucosal stitches by using Vicryl 2-0. Warm 6 -liters of normal saline was used to wash peritoneal cavity. After shifting in ward patient was kept Nil Per Oral for 3- days. In this time patient was given IV fluids and antibiotics. Vitals were recorded daily and a chart of daily intake and output was maintained. Infection was examined at the place of wound, daily dressing was also done. After patient has passed stools, NG tube was removed on 4^th post-operative day. Semi-solid food was allowed on 5^th post-operative day and fill diet was allowed on 7^th post-operative day.

Data was analyzed by SPSS version 17.0. Age and frequency was recorded in mean and standard deviation while gender and results like wound infection and intra-abdominal collection was calculated in percentages. Value of <0.05 was taken significant.

Table 1: Age and Gender

Tale 2 represent the major outcome of this study which is that maximum number of patients showed the uneventful recovery in which mostly were males. Our study showed that only 4% of victims suffered from wound infection.

Table 2: Distribution of Males and Females According to Complications

Most crucial health problem is trauma, which increases the burden on health system by 10-30%. It requires a co-ordinated care from emergency department to rehabilitation to help a severely injured patient(16).

Our study concludes that mostly victims in traumatic abdominal injuries were male. There were 245 males (92%) and 20(7.5) females. As males are the read earner for our families this causes the major loss to country because the victims belonged to productive age groups. Earlier studies from Nigeria, South Africa and Saudi Arabia also concluded the same results in age group 18-20. A study done in Peshawar by Maurice E et al on homicide and deaths stated the similar result, that male comprises 86.15% of homicide victim, from which 32% were in their 3^rd decade of life(17). In another study from Lahore Bashir along with others deducted that victims of intra-abdominal injuries were 88% males from which 42% were in the range of 21-30 years(18). In another study done by Salimi J along with others in Iran on abdominal trauma stated that blunt trauma in males are more common than penetrating trauma that is 40.8% and is more common in males. The reason for this is the irresponsible and risk taking behavior of young generation(19). In addition to this, males are more exposed to outdoor activities which in return expose them to violence and street quarrel(20). A study done in 2009 by S Chand along with others represented that penetrating gut injuries are more common in males than females. In his study 66 males were added and 16 were females  within the age of 18-60 years(21). D Hussain also favor our study by reporting that 74 victims were males and 26 were females and majority victims were within the age of 30-40 years(22). Similarly, a study done by AK Nayak in 2019 showed that54.1% were males and 45.9% were females with mean age of 16-80 years (3).

Our study showed that out of 265 patients 199 were those who made uneventful recovery, from which 112 were males and 87 were females. Total of 33 patients had post-operative complication among which 25 were males and 8 were females.  Similar study was done in surgical department of university of Kanas where the morbidity was 23%, which is also similar to our results(23). Another study done by Dildar Hussain along with others in 2009 showed 60% victims recovered without major complication but his study also showed the mortality rate of 1% which is contrary to our study(24). Similarly a study done by MF Haque et al in 2022, showed that morbidity and mortality in traumatic victims have decreased over the time and it can become to none y introducing new procedure in hospitals(25).

Infection of wound after operation is the most common complication. In our study although every patient received pre-operatively prophylactic antibiotics and also given antibiotics after operation but still from 33 patients who acquired complications, 9 males  and 3 females developed wound infection, which is lesser than the study done by Clark and Conrad JK(26). In another prospective study done by ME Asuquo et al stated that 5.1% patients had wound infection which is lesser than our study(27). S Chand et al in 2009 showed that 9.75% victims developed wound infection which is more than our study(28). D Hussain et al study showed wound infection of 52% which is far greater than our study(22).

The results of our study were analyzed in terms of complication such as wound infection, intra –abdominal collections etc. and uneventful recovery. It is concluded that repair with single layer extra-mucosal was simple, easy and less time consuming. The results were beneficial, helpful and can be compared with other national and international studies undergone in similar criteria.

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