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Published on: September 18, 2017
Anorectal injury in pelvic blast
1Royal Centre for Defence Medicine, Birmingham, UK.
Journal of the Royal Army Medical Corps
|May 2, 2013
Summary
Destructive anorectal injuries are increasingly seen in military conflicts. Current evidence does not support abandoning the established four D
Area of Science:
- Military Medicine
- Trauma Surgery
- Colorectal Surgery
Background:
- The Afghanistan campaign has seen a rise in severe anorectal injuries.
- Limited evidence exists to guide the management of these injuries.
- Existing military and civilian data offer insights but lack comprehensive strategies.
Purpose of the Study:
- To review historical and contemporary data on anorectal injuries from military conflicts.
- To evaluate current management strategies for destructive anorectal injuries.
- To inform evidence-based approaches for these challenging injuries.
Main Methods:
- Review of historical military records.
- Analysis of civilian reports and case studies.
- Examination of contemporary military data on pelviperineal blast injuries.
Main Results:
- No evidence contradicts the established "four D's" of management: diversion, distal washout, drainage, and direct repair.
- Historical military dogmas have been challenged by later civilian reports.
- Contemporary military data on blast injuries are limited regarding anorectal trauma.
Conclusions:
- The "four D's" (diversion, distal washout, drainage, direct repair) remain a valid management doctrine.
- Sound surgical judgment is crucial for managing high-morbidity anorectal injuries.
- Further research is needed to address knowledge gaps in pelviperineal blast injury management.
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