Historical Perspectives on Colorectal Trauma Management

Abstract

The authors discuss the history and evolution of management of traumatic wounds to the colon and rectum, summarizing early management parallel with the history of armed conflict followed by the increase in research and management interest by civilian centers in the post-Vietnam era. They explore the strong opinions of the early thought-leaders such as DeBakey and Ogilvie, detailing factors that may have impacted their views. The current literature on optimal management of both colon and rectal trauma is reviewed, including the contentious debate over which patients may benefit from diversion. Current organ injury staging and clinical practice guidelines are also reviewed, as well as lessons learned by the U.S. military in recent conflicts in Iraq and Afghanistan. Understanding of the evolution of colon and rectal trauma management, as well as the current literature, will help surgeons in their decision-making and management of these challenging injuries.

WSES guidelines on blunt and penetrating bowel injury: diagnosis, investigations, and treatment

“…When faced with bowel injuries management options include (1) primary repair, (2) bowel resection with or without anastomosis, or (3) stoma (either at the site of injury or proximally) [ 84 ]. A primary anastomosis is performed at the time of initial laparotomy, whereas a delayed primary anastomosis is one that is usually performed at the time of the relook laparotomy, usually within 48–72 h, but can be performed on the third or fourth re-look if required.…”

Penetrating colonic trauma and damage control surgery: Anastomosis or stoma?

“…Wartime experience actively discouraged primary repair due to the high risk of anastomotic breakdown. 1 This approach held sway for three decades following World War II and was only challenged in the late 1970s. 2 As resuscitation, operative techniques, anaesthesia and pre-hospital retrieval all improved, a substantial body of literature emerged to demonstrate that primary repair of most colonic injuries is safe.…”

Isolated recto-vaginal septum injury during parturition: Single center experience

“…[ 29 ] In injuries with a distal 1/3 rectum localization, transanal repair with the help of anal retractors can also be technically challenging due to the inadequate field of view and lack of space for manipulation of surgical instruments. [ 30 ] For this reason, various transanal repair methods have been used, including transanal endoscopic operation, transanal endoscopic microsurgery, and endoscopic hemoclips, with reported success. [ 31 , 32 ] Using transanal repair methods, limited injuries from surgical procedures such as endoscopic submucosal dissection and rectal injuries after colonoscopic procedures or blunt trauma have successfully been repaired without the need for diversion.…”