Contemporary management of rectal trauma - A South African experience (original) (raw)
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Management of Colonic and Rectal Injuries : A multicenter study
2017
Colorectal injuries are associated with septic complications in a high percentage of abdominal injuries. Proper initial management of colorectal injuries will significantly reduce septic complications and consequently mortality. The management of colorectal trauma has evolved considerably over the past several decades. The objective is to study the current surgical management of colonic and rectal injuries and to compare the morbidity and mortality of primary repair with faecal diversion. This is a prospective descriptive hospital based multicenter study conducted at Omdurman Military Hospital, El Obeid Military Hospital and Omdurman Teaching Hospital in the period from March 2014 to February 2015. Fifty two patients fulfilled the criteria for inclusion and analysis. More than half of colorectal injuries were managed with diversion. When comparing left with right-sided injuries, there was a trend toward increased stoma placement in patients with left-sided injuries (87.5% vs. 4.3%) ...
Fifteen Years Experience of Managing Penetrating Extra-Peritoneal Rectal Injuries
Surgical Medicine Open Access Journal, 2018
Fifteen Years Experience of Managing Penetrating Extra-peritoneal Rectal Injuries. Background: Although civilian injuries are generally less severe, they nevertheless remain a challenging problem for the surgeons. In isolated rectal injury patients, though proximal diversion, pre-sacral drainage, distal rectal wash-out and wound debridement are the various surgical options employed in various combinations, the optimum strategy especially for civilian injuries remains unknown. We reviewed our experience of managing penetrating extra peritoneal rectal injuries. Methods: We conducted a Retrospective review of Adult patients with penetrating extra-peritoneal rectal injuries. Follow-up information of at least one month was needed for early post-operative complications. Results: A total number of fifteen patients met inclusion criteria. Median age of our patients was 46 years with range being 20-80 years. All our patients were males. Thirteen of our patients (86%) suffered from gunshot injury while one was a blast victim and one had a stab injury to rectum. Nine patients (60%) had pelvic fracture associated with rectal injury. Diversion stoma was made in all of our patients. Overall post-operative morbidity was 40%. Two patients developed necrotizing fasciitis and required repeated debridements followed by graft placement and one patient developed intra-abdominal abscess which was treated by radiological guided drain placement and antibiotics. Conclusion: Drainage with fecal diversion is the most commonly employed management of extra-peritoneal rectal injuries. Delayed or inadequate drainage can lead to disastrous consequences including necrotizing fasciitis, intra-abdominal abscess
Colon and rectal injuries: Contemporary management
Hellenic Journal of Surgery, 2011
Colon and rectal injuries pose major challenges for the operating surgeon. Modern management takes into account the time elapsed from injury, the site and extent of the injury and the overall status of the patient. Colostomy in every case has evolved to become a more selective approach. Primary anastomosis is now considered feasible in most cases. The long-standing different approach to right and left colon injuries is debated. Intraperitoneal rectal injuries can be managed similar to left colon injuries by primary repair, whereas the mainstay of management of extraperitoneal injuries remains proximal colostomy. The extent of injury, associated abdominal injuries, presence of shock, number of blood transfusions and the time from injury to operation determine the decision-making process and the prognosis for these patients.
Management of Civilian Extraperitoneal Rectal Injuries
Asian Journal of Surgery, 2006
Management of Civilian Extraperitoneal Rectal Injuries of rectal and associated-organ damage is dependent on the mechanism of trauma. Rectal injuries are unlikely to be the cause of morbidity or mortality in the first few days following injuries, when polytraumatized patients have other factors that can cause death. 2,5 The management of polytraumatized patients should follow an established protocol of primary survey, resuscitation, stabilization, secondary survey and definitive treatment. 8 During the secondary survey, digital rectal examination should be performed, especially in patients with suspected rectal injury; gross rectal blood, wounds in close proximity, pelvic fracture, injuries to the genitourinary tract and lower abdominal pain or tenderness point to the possibility of rectal injury. 1,5 In most series, negative digital rectal examination did not exclude the diagnosis. 9,10 Procto
Unusual extraperitoneal rectal injuries: a retrospective study
European Journal of Trauma and Emergency Surgery, 2012
Purpose Rectal injuries, which are rarely encountered because of the anatomic characteristics, occur due to penetrating traumas. In the current study, we aimed to present experiences gleaned from our clinic concerning rarely encountered unusual rectal injuries, including those cases presented for the first time. Methods Eleven patients who had been treated for unusual rectal injuries in the General Surgery Clinic of Dicle University between 2004 and 2011 were retrospectively reviewed. Results The reasons for rectal injuries included foreign bodies in four cases, sexual intercourse in three cases, iatrogenic injuries in two cases, electric shock in one case, and animal horns in one case. All cases had extraperitoneal rectal injuries and all injuries were grade 2 injuries, except for the electrical burn. Primary repair was adequate for the treatment of six patients. Four patients underwent primary repair and ostomy, whereas one of the patients underwent debridement and an ostomy. The patients recovered without complications, except for one patient with sphincter insufficiency.
Outcomes and management of rectal injuries in children
Pediatric Surgery International, 2007
In the pediatric population, rectal injuries usually occur as a result of motor vehicle collisions. There has been an increased interest in selective diversion of rectal injuries in adults and increased utilization of laparoscopy both as a diagnostic and therapeutic adjunct. The aim of the study was to review our institutional experience with rectal injuries to determine if there was a subset of patients who could be managed with selective diversion. The medical records of children admitted with a rectal injury to Hospital for Sick Children, Toronto, over the last 20 years were retrospectively reviewed. Data abstraction included patient demographics, mechanism of injury, injury severity score, associated injuries, presenting symptoms, methods of diagnosis, treatment and resultant complications. Nine patients with rectal injuries were identified. The average injury severity score (ISS) was 19.3. Two patients with penetrating injuries underwent laparoscopy. Laparoscopy was able to define the intraperitoneal extension of injuries and guide the colostomy. Primary repair without a diverting colostomy was performed in 3 patients (2 intraperitoneal and 1 extraperitoneal injury) without complications. Based on the limited sample size, one should avoid making any definitive recommendations but, it appears, primary repair without fecal diversion can be performed safely in select children in spite of a longer time to surgery. Laparoscopy may be used for the immediate management of the penetrating trauma patient to rule out intraperitoneal extension, repair a perforation and guide the colostomy if necessary.
Military Medicine, 2013
The aim of this study was to analyze the surgical management and associated complications of penetrating rectal injuries sustained in Operation Iraqi Freedom and Operation Enduring Freedom. Methods: A retrospective review was performed using the Joint Theater Trauma Registry. U.S. military personnel injured in Iraq and Afghanistan from October 2003 to November 2008 were included. The surgical management of rectal injuries was evaluated, specifically looking at the utilization of diversion with ostomy, distal washout, and presacral drainage. Complications were compared between the treatment groups. Results: 57 patients who sustained a penetrating rectal injury were included in this study. Surgical management included diversion and ostomy alone in 34 patients (60%), diversion and distal washout in 11 patients (19%), diversion and drainage in 8 patients (14%), and diversion, distal washout, and drainage in 4 patients (7%). Complications were identified in 21% of patients. There were no deaths in the study group. Logistical regression failed to show a correlation between postoperative complications with either distal washout (p = 0.33) or presacral drainage (p = 0.9). Conclusions: The majority of patients were successfully managed with fecal diversion alone, suggesting that drainage and distal washout may be unnecessary steps in the management of high-velocity, penetrating rectal injuries.
Penetrating Bladder Trauma: A High Risk Factor for Associated Rectal Injury
Advances in Urology, 2014
Demographics and mechanisms were analyzed in prospectively maintained level one trauma center database 1990-2012. Among 2,693 trauma laparotomies, 113 (4.1%) presented bladder lesions; 51.3% with penetrating injuries ( = 58); 41.3% ( = 24) with rectal injuries, males corresponding to 95.8%, mean age 29.8 years; 79.1% with gunshot wounds and 20.9% with impalement; 91.6% arriving the emergence room awake (Glasgow 14-15), hemodynamically stable (average systolic blood pressure 119.5 mmHg); 95.8% with macroscopic hematuria; and 100% with penetrating stigmata. Physical exam was not sensitive for rectal injuries, showing only 25% positivity in patients. While 60% of intraperitoneal bladder injuries were surgically repaired, extraperitoneal ones were mainly repaired using Foley catheter alone (87.6%). Rectal injuries, intraperitoneal in 66.6% of the cases and AAST-OIS grade II in 45.8%, were treated with primary suture plus protective colostomy; 8.3% were sigmoid injuries, and 70.8% of all injuries had a minimum stool spillage. Mean injury severity score was 19; mean length of stay 10 days; 20% of complications with no death. Concomitant rectal injuries were not a determinant prognosis factor. Penetrating bladder injuries are highly associated with rectal injuries (41.3%). Heme-negative rectal examination should not preclude proctoscopy and eventually rectal surgical exploration (only 25% sensitivity).