A novel approach for rectal trauma. The use of a transanal platform to repair a combined high-velocity rectal gun fire wound

Abstract

Up to 80% of the rectal injuries reported in US trauma centers occur secondary to firearm injuries. Rectal gunshot wounds are associated with significant morbidity and mortality. Diverse surgical approaches and techniques have been described; however, controversy persists regarding the best management for these complex injuries. Nowadays, no single approach has proven to provide optimal results when dealing with these injuries. We present a case of a young male that suffered a combined (intra-extraperitoneal) gun shot gun to the rectus and the use of a transanal platform to repair it.

Management of a traumatic anorectal full-thickness laceration: a case report

“…Guidelines for rectal injuries continue to evolve, and an emphasis is now placed on more conservative approaches [5]. Historically, the first studies were conducted on rectal trauma that occurred during wars.…”

“…Traumatic injuries of the rectum are classified in terms of their location (intraperitoneal vs. extraperitoneal) and according to the American Association for the Surgery of Trauma rectum injury scale in grades from I to V [6]. However, the choice of treatment depends mainly on other factors such as hemodynamic instability, level of contamination, and other concomitant injuries [5]. As described in the literature, intraperitoneal rectal lesions are often treated with proximal diversion, although these patients showed a higher rate of abdominal complications (22% vs. 10%).…”

“…However, most of the lesions involved the extraperitoneal rectum, and 75% of these lesions were classified as grades I and II, with a high incidence of associated pelvic and abdominal lesions [8]. The causes for morbidity and mortality due to traumatic injuries of the extraperitoneal rectum in-clude the difficulty in obtaining adequate exposure of the intervention field and the delay in diagnosis [5]. While surgeons initially shared the "4 D's" strategy, given the good results since the Vietnam War, when it was proposed as the standard of care, the literature has subsequently begun to review the role of some of the "4D's. "…”