Presacral drainage in penetrating extraperitoneal rectal injuries: is it necessary?

The objective was to evaluate the need for presacral drainage in low velocity penetrating rectal injury. Standard management of penetrating injuries to the extraperitoneal rectum from high velocity injury consists of debridement, diversion, drainage, and distal washout. A retrospective, descriptive review of penetrating rectal injury from 1983 to 1993 was undertaken. Independent variables included age, sex, injury severity score, mechanism of injury, caliber of weapon, associated injuries, pre-/intra-/postoperative antibiotics, length of stay, and presacral drainage. Dependent variables included wound infection and intra-abdominal abscess. Twenty-two consecutive patients met inclusion criteria. Mean injury severity score was 14.2 (SD +/- 2.3). Proximal colostomy was performed on 20; distal washout in 12 (60%). Eight (40%) of the 20 underwent presacral drainage; 12 (60%) did not. Use of presacral drainage was based on attending surgeon's preference. Groups were comparable regarding all independent variables. Routine use of presacral drainage in managing low velocity rectal wounds may not be necessary. Absence of drainage did not increase infectious complications.