Rectal Injury After Foreign Body Insertion: Secondary Analysis From the AAST Contemporary Management of Rectal...

Area of Science:

• Trauma surgery
• Colorectal surgery
• Surgical outcomes

Background:

• Retained rectal foreign bodies present a common clinical challenge.
• The epidemiology, injury severity, and outcomes of these injuries are not well-understood.
• This study investigates rectal injuries resulting from foreign body insertion.

Purpose of the Study:

• To define the epidemiology of retained rectal foreign bodies.
• To assess injury severity and patient outcomes.
• To compare management strategies for rectal foreign bodies.

Main Methods:

• A multi-institutional trial involving 22 level I trauma centers (2005-2014).
• Retrospective analysis of patients with rectal injuries due to foreign body insertion.
• Classification of injuries into partial thickness (AAST grade I) and full thickness (AAST grades II-V) and subgroup analysis by management (nonoperative vs. operative).

Main Results:

• 33 patients were included, with a mean age of 41 years; 85% were male.
• 11 patients (33%) had full thickness injuries, and 22 (67%) had partial thickness injuries.
• Partial thickness injuries managed nonoperatively had a significantly shorter hospital length of stay (2 days) compared to operative management (4 days).

Conclusions:

• Partial thickness rectal injuries typically do not require surgical intervention.
• Operative management of partial thickness injuries, often due to difficulty excluding full thickness injuries, led to longer hospital stays.
• Nonoperative management is recommended for retained rectal foreign bodies unless a full thickness injury is definitively identified.