World Journal of Surgery

, Volume 31, Issue 6, pp 1347–1353 | Cite as

Civilian Extraperitoneal Rectal Gunshot Wounds: Surgical Management Made Simpler

  • Pradeep H. Navsaria
  • Sorin Edu
  • Andrew J. Nicol



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.


  1. 1.
    Falcone RE, Carey LC (1988) Colorectal trauma. Surg Clin North Am 68:1307–1318PubMedGoogle Scholar
  2. 2.
    Wallace C (1917) A study of 1200 cases of gunshot wounds of the abdomen. Br J Surg 4:679–743CrossRefGoogle Scholar
  3. 3.
    Ogilvie WH (1944) Abdominal wounds in the Western Desert. Surg Gynecol Obstet 78:225–238Google Scholar
  4. 4.
    Lavenson GS, Cohen A (1971) Management of rectal injuries. Am J Surg 122:226–230PubMedCrossRefGoogle Scholar
  5. 5.
    McGrath V, Fabian T, Croce M, et al. (1998) Rectal trauma: management based on anatomic distinctions. Am Surg 12:1136–1141Google Scholar
  6. 6.
    Weinberg JA, Fabian TC, Magnotti LJ, et al. (2006) Penetrating rectal trauma: management by anatomic distinction improves outcome. J Trauma 60:508–514PubMedGoogle Scholar
  7. 7.
    Navsaria PH, Graham R, Nicol A (2001) A new approach to extraperitoneal rectal injuries: laparosocpy and diverting sigmoid colostomy. J Trauma 51:532–535PubMedGoogle Scholar
  8. 8.
    Navsaria PH, Shaw JM, Zellweger R, et al. (2004) Diagnostic laparosocopy and diverting sigmoid loop colostomy in the management of civilian extraperitoneal rectal gunshot injuries. Br J Surg 91:460–464PubMedCrossRefGoogle Scholar
  9. 9.
    Ivatury RR, Licata J, Gunduz Y, et al. (1991) Management options in penetrating rectal injuries. Am Surg 57:50–55PubMedGoogle Scholar
  10. 10.
    Tuggle D, Huber PJ (1989) Management of rectal trauma. Am J Surg 148:806–809CrossRefGoogle Scholar
  11. 11.
    Mangiante EC, Graham A, Fabian T (1986) Rectal gunshot wounds: management of civilian wounds. Surgery 52:37–40Google Scholar
  12. 12.
    Burch JM, Feliciano DV, Mattox KL (1989) Colostomy and drainage for civilian rectal injuries. Is that all? Ann Surg 209:600–611Google Scholar
  13. 13.
    Velmahos GC, Gomez H, Falabella A, et al. (2000) Operative management of civilian rectal gunshot wounds: simpler is better. World J Surg 24:114–118PubMedCrossRefGoogle Scholar
  14. 14.
    Levy RD, Strauss P, Aladgem D, et al. (1995) Extraperitoneal gunshot injuries. J Trauma 38:273–277PubMedGoogle Scholar
  15. 15.
    Haas PA, Fox TA (1977) Civilian injuries of the rectum and anus. Dis Col Rect 2:17–23Google Scholar
  16. 16.
    Brunner RG, Shatney CH (1987) Diagnostic and therapeutic aspects of rectal trauma. Blunt versus penetrating. Am Surg 53:215–219PubMedGoogle Scholar
  17. 17.
    Gonzalez RP, Phelan H, Hassan M, et al. (2006) Is fecal diversion necessary for nondestructive penetrating extraperitoneal rectal injuries. J Trauma 61:815–819PubMedGoogle Scholar
  18. 18.
    Shannon FL, Moore E, Moore F, et al. (1988) Value of distal colon washout in civilian rectal trauma— reducing gut bacterial translocation. J Trauma 28:989–994PubMedGoogle Scholar
  19. 19.
    Armstrong RG, Schmidt HJ, Paterson CT (1983) Combat wounds of the extraperitoneal rectum. Surgery 74:570–583Google Scholar
  20. 20.
    Thomas DD, Lesion MA, Dykstra BJ, et al. (1990) Management of rectal injuries: dogma vs. practice. Am Surg 56:507–510Google Scholar
  21. 21.
    Bostic PJ, Johnson DA (1993) Management of rectal injuries. J Natl Med Assoc 85:460–463Google Scholar
  22. 22.
    Gonzales RP, Falimirski M, Holevar R (1998) The role of presacral drainage in the management of penetrating rectal trauma. J Trauma 45:656–666CrossRefGoogle Scholar
  23. 23.
    Franko ER, Ivatury RR, Schwalb DM (1993) Combined penetrating rectal and genitourinary injuries: a challenge in management. J Trauma 34:347–353PubMedGoogle Scholar
  24. 24.
    Trunkey D, Hays RJ, Shires GT (1973) Management of rectal trauma. J Trauma 13:411–415PubMedGoogle Scholar
  25. 25.
    Levine JH, Longo W, Pruitt C, et al. (1996) Management of selected rectal injuries by primary repair. Am J Surg 172:575–578PubMedCrossRefGoogle Scholar
  26. 26.
    Steinig JP, Boyd CR (1996) Presacral drainage in penetrating extraperitoneal rectal injuries: is it necessary. Am Surg 62:765–767PubMedGoogle Scholar
  27. 27.
    Morken JJ, Kraatz J, Balcos EG, et al. (1999) Civilian rectal trauma: a changing perspective. Surgery 126:693–700PubMedGoogle Scholar

Copyright information

© Société Internationale de Chirurgie 2007

Authors and Affiliations

  • Pradeep H. Navsaria
    • 1
  • Sorin Edu
    • 1
  • Andrew J. Nicol
    • 1
  1. 1.Trauma CenterTrauma Unit – C14 Groote Schuur Hospital, and Faculty of Health Sciences University of Cape TownCape TownSouth Africa

Personalised recommendations