Contemporary management of penetrating colon trauma

Braveman, Joshua M.; Malangoni, Mark A.

doi:10.1053/j.scrs.2004.10.006

Cited by 1 publication

(1 citation statement)

References 49 publications

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“…Across 39 studies, penetrating trauma accounted for 85% of rectal injuries with about 6% due to blunt mechanisms (Merlino and Reynolds, 2004). A small number are caused by other means including surgical or endoscopic mishap, obstetric trauma (Thakar and Sultan, 2003) or misadventure such as autoerotism and sexual assault (Braveman and Malangoni, 2004).…”

Section: Epidemiologymentioning

confidence: 99%

Rectal trauma in adults

Barkley

Khan

Garner

2012

Trauma

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Rectal trauma is associated with high rates of morbidity and mortality and generally affects young males due to its aetiology of violent crime and vehicular collision. Historically, management has followed principles derived from military practice, with faecal diversion, pre-sacral drainage and distal washout being mandatory. Civilian trauma studies examining management of colon and rectum injuries from the early 1950s identified major differences in the level of energy transfer between civilian and military wounds, given that the vast majority are penetrating in nature. This led to a re-evaluation of the necessity for these interventions for all rectal injuries. Current management depends on whether the injury is intra- or extraperitoneal, with those above the peritoneal reflection being readily accessible and amenable to treatment as for colon injury. Extraperitoneal injuries remain difficult to access and direct repair is usually impossible; the mainstay of treatment in most instances remains faecal diversion. The role of pre-sacral drainage and distal washout remains contentious in the realms of civilian rectal injury but retains a place in battlefield or other high-energy transfer rectal injuries where aggressive early management reduces septic complications. This article reviews the historical and current evidence for the management of both civilian and military extraperitoneal rectal injuries.

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Section: Epidemiologymentioning

confidence: 99%