Traumatic perineal laceration

Four cases of pelvic trauma associated with a deep perineal tear are reported. The mechanism of injury, preoperative and operative care of this type of injury are discussed. The theory that the tear is similar to an explosion is presented. Categories of anorectal injury are listed. As expected, genitourinary and rectal injuries as well as hemorrhage are the primary concerns with this type of trauma. Management consists of careful evaluation for genitourinary tract injury followed by careful inspection of the perineal tear in the operating room. Rectal examination is crucial and proctosigmoidoscopy is advised for all injuries. Sepsis is the most important complication of the perineal tear. Prevention begins with mandatory colostomy for all patients. The loop colostomy serves as the necessary totally diverting colostomy. Equally important is evacuation and washout of distal fecal content of colon during operation. Hemorrhage may assume greater importance than with closed injuries due to the loss of tamponade. Hypogastric ligation at the time of exploration and colostomy may be beneficial. Drainage of the pararectal space is necessary when the rectum is directly involved in the tear.