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Rectal trauma: management based on anatomic distinctions

V McGrath1, T C Fabian, M A Croce

  • 1Department of Surgery, University of Tennessee, Memphis 38163, USA.

The American Surgeon
|December 8, 1998
PubMed
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Management of penetrating rectal injuries depends on location. Intraperitoneal injuries often heal with primary repair, while extraperitoneal wounds require careful consideration of repair, drainage, and washout to minimize presacral infection risks.

Area of Science:

  • Trauma Surgery
  • Colorectal Surgery
  • Surgical Management

Background:

  • Rectal wound management principles, including diversion, repair, drainage, and washout, have evolved but remain debated.
  • Confusion exists due to imprecise definitions of injury location and retroperitoneal involvement.
  • A Level I trauma center analyzed 5-year experience with penetrating rectal injuries.

Purpose of the Study:

  • To analyze outcomes of penetrating rectal injuries based on anatomical location (intraperitoneal vs. extraperitoneal).
  • To evaluate the effectiveness of different management strategies for extraperitoneal rectal wounds.
  • To clarify optimal surgical approaches for rectal trauma.

Main Methods:

  • Retrospective analysis of 58 penetrating rectal injuries (92% gunshot wounds) over 5 years.

Related Experiment Videos

  • Classification of injuries as intraperitoneal (IP) or extraperitoneal (EP) based on location.
  • Evaluation of management strategies including primary repair, diversion, presacral drainage, and distal washout.

    • Main Results:

    • 16 injuries were IP, and 42 had an EP component.
    • 10 patients underwent repair without diversion (6 IP, 4 EP) with no leaks.
    • Presacral infection (PI) was the only complication specifically associated with EP injuries; 3 PIs occurred in 38 diverted EP wounds.
    • Management strategies for EP wounds showed no statistically significant differences in PI rates, but trends suggested potential benefits for repair and presacral drainage.

    Conclusions:

    • Most intraperitoneal rectal injuries can be managed with primary repair.
    • Extraperitoneal wounds in the upper two-thirds of the rectum typically require repair.
    • Extraperitoneal wounds in the lower one-third, if explored and repaired, do not need drainage; otherwise, presacral drainage is recommended to reduce presacral abscess incidence.