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Rectal Trauma: Evidence-Based Practices.

Michael S Clemens1, Kaitlin M Peace1, Fia Yi1

  • 1Division of Colon and Rectal Surgery, San Antonio Military Medical Center, Sam Houston, Texas.

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|January 31, 2018
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Summary
This summary is machine-generated.

Rectal trauma management is distinct from colon trauma due to unique anatomy. Recent experiences and revised strategies, including debridement, drainage, diversion, and distal irrigation, are improving treatment outcomes for rectal injuries.

Keywords:
diversiondrainagerectal traumarectumtrauma

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Area of Science:

  • Trauma Surgery
  • Colorectal Surgery
  • Surgical Anatomy

Background:

  • Rectal trauma is often mismanaged by grouping it with colon trauma, despite its unique anatomical considerations.
  • The rectum's intra- and extraperitoneal segments present distinct challenges in trauma management.
  • Traditional management principles are being re-evaluated based on recent surgical experiences and evolving understanding.

Purpose of the Study:

  • To review the specific anatomy and injury types associated with rectal trauma.
  • To present an updated treatment algorithm for rectal trauma based on current literature.
  • To address controversial aspects and offer expert opinions on rectal trauma management.

Main Methods:

  • Comprehensive literature review focusing on rectal trauma management.
  • Analysis of established treatment principles, including the 'four Ds' (debridement, drainage, diversion, distal irrigation).
  • Development of a treatment algorithm informed by evidence and clinical experience.

Main Results:

  • Rectal trauma requires a management approach distinct from colon trauma due to anatomical variations.
  • Experiences from recent conflicts have informed advancements in surgical techniques and strategies.
  • A proposed treatment algorithm offers a structured approach to managing rectal injuries.

Conclusions:

  • Rectal trauma is a unique surgical entity necessitating specialized management strategies.
  • The 'four Ds' remain foundational, but their application is refined by current evidence and experience.
  • This review provides an updated perspective on managing rectal trauma, addressing historical dogma and controversial points.