Civilian rectal trauma: the surgical challenge

Using the Department of Surgery, Radiology, Anaesthesia and Intensive Care's operative database and information from the Trauma Registry for patients presenting after 1998, a retrospective study of patients seen between the period 1992 and 2002 was done at the University Hospital of the West Indies with the objective of determining the treatment and outcome of patients with a diagnosis of rectal trauma. Over the 10-year period, 45 patients were seen with this diagnosis. Eighty-two per cent of the cases were males, with a mean age of 29.8 years (range 16-70 years) while the eight female patients had a mean age of 36.8 years. Low velocity gunshot wounds accounted for 64% of the entire group and for 78% in males. Six of the eight cases seen in females were iatrogenic occurring during gynaecological operations. Sixty-three per cent of rectal injuries were associated with other injuries with the genitourinary system most commonly involved The majority (83%) were diagnosed preoperatively by visualization of the rectal wound or the presence of blood on proctosigmoidoscopy. All the patients had peri-operative antibiotics and diversion with a proximal sigmoid colostomy. Fifteen per cent of cases had presacral drain insertion. Distal rectal washout was not used. There were no deaths. Seventy-three per cent of patients had closure during the period under review at an average time of 8.5 months after initial surgery. The other 27% after an average of 23 months did not have documented closure. The mainstay of treatment for civilian rectal trauma remains diverting sigmoid loop colostomy, despite its morbidity, and peri-operative antibiotics.