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Fecal continence following complex anorectal trauma in children
Katie W Russell1, Elizabeth S Soukup1, Ryan R Metzger1
1Division of Pediatric Surgery, Primary Children's Medical Center, University of Utah, Salt Lake City, UT.
Insights
Most children with traumatic anorectal injuries achieve long-term fecal continence after surgical repair. Some severe cases may require ongoing bowel management programs for optimal outcomes.
Area of Science:
- Pediatric surgery
- Trauma surgery
- Colorectal surgery
Background:
- Complex anorectal injuries are rare in pediatric populations.
- Assessing long-term fecal continence after repair is crucial for patient outcomes.
Purpose of the Study:
- To evaluate long-term fecal continence in children following surgical repair of traumatic anorectal injuries.
Main Methods:
- Retrospective review of pediatric trauma registry (2003-2012).
- Inclusion criteria: traumatic injuries to anus/rectum requiring surgical repair involving anal sphincters and/or rectum.
- Detailed review of selected patients' data.
Main Results:
- Twenty-one pediatric patients identified with traumatic anorectal injuries (0.2% of activations).
- Majority (90%) achieved fecal continence post-repair; 52% were male, median age 9 years.
- Penetrating trauma was common (48%); wound infections occurred in 19%.
Conclusions:
- Anatomic reconstruction of the anal sphincter mechanism leads to good long-term fecal continence in most pediatric trauma patients.
- Nerve or severe crush injuries may necessitate formal bowel management programs.
- Continued follow-up is important for managing potential long-term complications.
Background:
Complex injuries involving the anus and rectum are uncommon in children. We sought to examine long-term fecal continence following repair of these injuries.
Methods:
We conducted a retrospective review using our trauma registry from 2003 to 2012 of children with traumatic injuries to the anus or rectum at a level I pediatric trauma center. Patients with an injury requiring surgical repair that involved the anal sphincters and/or rectum were selected for a detailed review.
Results:
Twenty-one patients (21/13,149 activations, 0.2%) who had an injury to the anus (n=9), rectum (n=8), or destructive injury to both the anus and rectum (n=4) were identified. Eleven (52%) patients were male, and the median age at time of injury was 9 (range 1-14) years. Penetrating trauma accounted for 48% of injuries. Three (14%) patients had accompanying injury to the urinary tract, and 6 (60%) females had vaginal injuries. All patients with an injury involving the rectum and destructive anal injuries were managed with fecal diversion. No patient with an isolated anal injury underwent fecal diversion. Four (19%) patients developed wound infections. The majority (90%) of patients were continent at last follow-up. One patient who sustained a gunshot injury to the pelvis with sacral nerve involvement is incontinent, but remains artificially clean on an intense bowel management program with enemas, and one patient with a destructive crush injury still has a colostomy.
Conclusions:
With anatomic reconstruction of the anal sphincter mechanism, most patients with traumatic anorectal injuries will experience long-term fecal continence. Follow-up is needed as occasionally these patients, specifically those with nerve or crush injury, may require a formal bowel management program.
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