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Management of Pediatric Rectal Trauma: A Four-Year ACS-TQIP Database Review
Omar Obaid1, Tania Torres-Ruiz2, Cory Criss1
1Department of Surgery, Nationwide Children's Hospital, Columbus, Ohio, USA.
Journal of Pediatric Surgery
|August 7, 2026
Summary
Pediatric rectal trauma is often managed non-operatively. When surgery is needed, primary repair is favored over diversion, with surgical technique not impacting outcomes.
Area of Science:
- Pediatric Surgery
- Trauma Surgery
- Colorectal Surgery
Background:
- Adult rectal trauma management has shifted towards primary repair, but pediatric data is limited.
- This study addresses the management and outcomes of pediatric rectal trauma nationwide.
Purpose of the Study:
- To assess the nationwide management strategies for pediatric rectal trauma.
- To evaluate the outcomes associated with different surgical techniques in pediatric rectal trauma.
- To identify predictors of management strategies and adverse outcomes.
Main Methods:
- Retrospective review of the American College of Surgeons-Trauma Quality Improvement Program (ACS-TQIP) database (2017-2020).
- Inclusion of pediatric patients with rectal injuries (rectal-AIS≥2).
- Analysis of operative management (trans-anal repair, transabdominal repair, diverting colostomy, distal rectal washout, presacral drainage, resection) and diagnostic endoscopy, along with outcomes (infectious complications, return to OR, ICU admission, mortality, length-of-stay).
Main Results:
- 641 children were included; 57% managed non-operatively, 43% surgically.
- Primary repair was more common than fecal diversion (diverting colostomy, distal rectal washout, presacral drainage).
- Higher rectal AIS predicted diverting colostomy; age 6-12 and higher rectal AIS were associated with adverse outcomes.
Conclusions:
- This is the largest cohort study on pediatric rectal trauma, showing a trend towards selective non-operative management.
- Primary repair is the predominant surgical approach when intervention is necessary.
- Surgical technique was not independently associated with patient outcomes after adjusting for confounders.