Rectal trauma in adults

Abstract

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.

Our opinion about the guide entitled as “evaluation of the wounding crimes described by Turkish Criminal Code with Forensic Science Perspective”

“…Barsakların distalindeki patolojik olayın veya anostomozun iyileşmesi sürecinde, perinenin travmatik defektleri gibi durumlarda, bölgenin dışkı akımından uzak tutulması amacıyla kolostomi açılabilmektedir (3). Geçici ve kalıcı olmak üzere iki tip kolostomi söz konusu olup, anorektal bölge travma / hastalıklarında kolostomi açma gereği duyulduğunda genellikle geçici kolostomi açıl-maktadır (4,5). Ancak anorektal bölgenin yüksek enerjili çoğul travmaları sonucu gelişen ve anorektumun çı-karılmasına neden olan durumlarda kalıcı kolostomiler açılabilmektedir (6).…”

Treatment of rectal war wounds

“…The study demonstrated a significant correlation between pelvic fractures, massive soft tissue injury and rectal injuries, resulting in a mortality rate of 33%. High-energy transfer injuries usually result in rectal injuries that require some form of local surgical debridement and repair in combination with a diverting colostomy for faecal diversion 7 8 11. In a cohort of colorectal injuries in 977 coalition forces serving in Iraq and Afghanistan rectal injury led to faecal diversion twice as often as colonic injury, with more than half of patients requiring an ‘ostomy’ (56.2%) 12…”

Management of Post-Traumatic Posterior Rectal Pouch Through a Posterior Approach

“…The decision-making strategy for the initial treatment of rectal injuries relies on a number of factors that include the anatomic site and cause of rectal injury, physiologic condition of the patient, and antibiotic use [2,3]. It has been recognized that the rectal injuries above the peritoneal reflection are readily accessible and amenable to treatment as for colonic injuries, and hence they are classically treated with primary repair with or without proximal diversion [4]; on the other hand, the extraperitoneal rectal injuries are usually more difficult to access and direct repair is usually impossible [5].…”

“…Furthermore, a recent multi-institutional study [8] found that the presacral drainage and rectal washout were independently associated with a three-fold increase in abdominal complications, recommending to avoid these measures in the management of extraperitoneal rectal injuries. While the role of presacral drainage and distal rectal washout in the setting of civilian rectal injury is debatable, they still have a place in the battlefield or other high-energy transfer rectal injuries in order to decrease septic complications, as Barkley et al [5] implied.…”