Management of penetrating extraperitoneal rectal injuries

Bosarge, Patrick L.; Como, John J.; Fox, Nicole; Falck‐Ytter, Yngve; Haut, Elliott R.; Dorion, Heath; Patel, Neel; Rushing, Amy P.; Raff, Lauren; McDonald, Amy A.; Robinson, Bryce R. H.; McGwin, Gerald; Gonzalez, Richard P.

doi:10.1097/ta.0000000000000953

Cited by 58 publications

(21 citation statements)

References 11 publications

(6 reference statements)

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“…The initial evaluation of any trauma patient should follow ATLS principles, where anorectal injuries are asses during the secondary survey, where digital rectal examination is mandatory but has a low value in detecting rectal injuries. 2,4 Besides localization of the injury (intra or extraperitoneal), traumatic rectal injuries are classified according to the American Association of the Surgery of Trauma (AAST) Rectum Injury Scale (Table 1), as they have to be defined as destructive or non-destructive injuries 5,6 ; however the operative decision making depends more on other factors such as: hemodynamic stability, concomitant lesions, degree of contamination and location of the injury. 7 Extraperitoneal injuries are associated with higher morbidity and mortality due to delays in diagnosis, difficulty in obtaining adequate exposure and inconsistencies in suggested methods of treatment, that affect outcomes negatively.…”

Section: Discussionmentioning

confidence: 99%

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

Guraieb-Trueba

Sánchez-Robles

Pérez-Morales

et al. 2020

Journal of Coloproctology

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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.

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Section: Discussionmentioning

confidence: 99%

“…Available data suggests that the use of a presacral drainage leads to an increase in mortality and infectious complications. 2,5 In 2016, the Eastern Association for the Surgery of Trauma guidelines recommend against the use of presacral drains.…”

Section: Discussionmentioning

confidence: 99%

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

Guraieb-Trueba

Sánchez-Robles

Pérez-Morales

et al. 2020

Journal of Coloproctology

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“…Management guidelines from the Eastern Association for the Management of Trauma (EAST) provide further rectal trauma management points [13]. This group conducted a systematic review of the literature from 1900 through 2014 for studies pertaining to penetrating, non-destructive extraperitoneal rectal injuries.…”

Section: Discussionmentioning

confidence: 99%

Femoral Head Dislocation into the Rectum Following Blunt Trauma

Ebeling

Clark

Erwin

et al. 2019

Cureus

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Traumatic hip dislocations require prompt diagnosis and treatment to prevent avascular necrosis of the femoral head. This injury is further complicated when there is an ipsilateral femur fracture. Here, we present what is likely the first reported case of a patient with traumatic hip dislocation and ipsilateral femur fracture with transrectal displacement of the femoral head. The patient presented to a level one trauma center in 2006 as a transfer from another facility after being thrown from a pickup truck. Upon initial evaluation, a foreign body was palpated in the rectum. Computed tomography (CT) imaging showed that the right femoral head was lodged within the pelvis. In the operating room, an exploratory laparotomy was performed, and anoscopy confirmed the placement of the femoral head within the rectal lumen. The femoral head was extracted from the rectum transanally. The operation was abbreviated, as the patient became hemodynamically unstable, and he was taken to the intensive care unit. He returned to the operating room the following day for a repeat washout and proximal diversion. Despite numerous orthopedic procedures and operative washouts, he ultimately underwent a right hip disarticulation. Physicians should be aware that intracorporeal femoral head displacement is possible in select patients who have experienced a high-energy trauma mechanism. This is a complicated, highly morbid injury that poses various management challenges to orthopedic and acute care surgeons.

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“…In the context of patients with high energy blunt trauma, a wide pubic symphysis, associated urogenital injuries and pelvic fractures (especially anteroposterior fractures by compression) should raise suspicion and guide further evaluation for concomitant rectal injuries 11 . Suspected rectal injuries must be evaluated through digital rectal examination, CT-Scan or proctoscopy if the patient´s hemodynamic status allows it 12 .…”

Section: Initial Approachmentioning

confidence: 99%

Rectal damage control: when to do and not to do

et al. 2021

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Rectal trauma is uncommon, but it is usually associated with injuries in adjacent pelvic or abdominal organs. Recent studies have changed the paradigm behind military rectal trauma management, showing better morbidity and mortality. However, damage control techniques in rectal trauma remain controversial. This article aims to present an algorithm for the treatment of rectal trauma in a patient with hemodynamic instability, according to damage control surgery principles. We propose to manage intraperitoneal rectal injuries in the same way as colon injuries. The treatment of extraperitoneal rectum injuries will depend on the percentage of the circumference involved. For injuries involving more than 25% of the circumference, a colostomy is indicated. While injuries involving less than 25% of the circumference can be managed through a conservative approach or primary repair. In rectal trauma, knowing when to do or not to do it makes the difference.

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Management of penetrating extraperitoneal rectal injuries

Cited by 58 publications

References 11 publications

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

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

Femoral Head Dislocation into the Rectum Following Blunt Trauma

Rectal damage control: when to do and not to do

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