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Management of extraperitoneal rectal injuries
P J Bostick1, D A Johnson, J F Heard
1Martin Luther King, Jr/Drew Medical Center, Charles R. Drew University of Medicine and Science, Los Angeles, California.
Journal of the National Medical Association
|June 1, 1993
Summary
Management of rectal injuries from gunshot wounds involves fecal diversion and presacral drainage, proving highly effective with no associated deaths. Primary repair did not impact outcomes in this study.
Area of Science:
- Trauma Surgery
- Colorectal Surgery
- Surgical Outcomes
Background:
- Extraperitoneal rectal injuries are often caused by penetrating trauma.
- Effective management is crucial to minimize morbidity and mortality.
Purpose of the Study:
- To review the management and outcomes of patients with extraperitoneal rectal injuries.
- To identify key therapeutic strategies for civilian rectal trauma.
Main Methods:
- Retrospective review of 28 consecutive cases of extraperitoneal rectal injuries.
- Analysis of injury mechanisms, diagnostic methods, surgical interventions, and complications.
Main Results:
- All injuries were due to gunshot wounds.
- Fecal diversion (colostomy) and presacral drainage were universally applied.
- Low infectious complication rate (3.6%) and zero mortality.
- Primary repair showed no significant effect on morbidity or mortality.
Conclusions:
- Fecal diversion and presacral drainage are the cornerstones of treating civilian rectal injuries.
- The role of distal rectal irrigation remains uncertain.
- Primary repair is not essential for favorable outcomes in these injuries.