Civilian Extraperitoneal Rectal Gunshot Wounds: Surgical Management Made Simpler
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Rectal injuries are associated with significant morbidity and mortality. Controversy persists regarding routine presacral drainage, distal rectal washout (DRW), and primary repair of extraperitoneal rectal injuries. This retrospective review was performed to determine the outcome of rectal injuries in an urban trauma center with a high incidence of penetrating trauma where a non-aggressive surgical approach to these injuries is practiced.
The records of all patients with a full-thickness penetrating rectal injury admitted to the Trauma Center at Groote Schuur Hospital over a 4-year period were reviewed. These were reviewed for demographics, injury mechanism and perioperative management, anatomical site of the rectal injury, associated intra-abdominal injuries and their management. Infectious complications and mortality were noted. Intraperitoneal rectal injuries were primarily repaired, with or without fecal diversion. Extraperitoneal rectal injuries were generally left untouched and a diverting colostomy was done. Presacral drainage and DRW were not routinely performed.
Ninety-two patients with 118 rectal injuries [intraperitoneal (7), extraperitoneal (59), combined (26)] were identified. Only two extraperitoneal rectal injuries were repaired. None had presacral drainage. Eighty-six sigmoid loop colostomies were done. Two (2.2%) fistula, one rectocutaneous, and one rectovesical, were recorded. There were nine (9.9%) infectious complications: surgical site infection (4), buttock abscess (1), buttock necrosis (1), pubic ramus osteitis (1), septic arthritis (2). No perirectal sepsis occurred.
Extraperitoneal rectal injuries due to low-velocity trauma can be safely managed by fecal diversion alone.
- 3.Ogilvie WH (1944) Abdominal wounds in the Western Desert. Surg Gynecol Obstet 78:225–238Google Scholar
- 5.McGrath V, Fabian T, Croce M, et al. (1998) Rectal trauma: management based on anatomic distinctions. Am Surg 12:1136–1141Google Scholar
- 11.Mangiante EC, Graham A, Fabian T (1986) Rectal gunshot wounds: management of civilian wounds. Surgery 52:37–40Google Scholar
- 12.Burch JM, Feliciano DV, Mattox KL (1989) Colostomy and drainage for civilian rectal injuries. Is that all? Ann Surg 209:600–611Google Scholar
- 15.Haas PA, Fox TA (1977) Civilian injuries of the rectum and anus. Dis Col Rect 2:17–23Google Scholar
- 19.Armstrong RG, Schmidt HJ, Paterson CT (1983) Combat wounds of the extraperitoneal rectum. Surgery 74:570–583Google Scholar
- 20.Thomas DD, Lesion MA, Dykstra BJ, et al. (1990) Management of rectal injuries: dogma vs. practice. Am Surg 56:507–510Google Scholar
- 21.Bostic PJ, Johnson DA (1993) Management of rectal injuries. J Natl Med Assoc 85:460–463Google Scholar