Trauma: Rectal Trauma

Rectum

General

  • About 80% Caused by GSW
  • 10% from Blunt Trauma
  • 6% from Transanal/Impalement Injury

AAST Rectum Injury Scale

Destructive Bowel Injury

  • Destructive Bowel Injury Definition:
    • > 50% Circumference
    • Devascularized

Rectal Perforation 1

Rectal Foreign Body 2

Diagnosis

  • Start with a CT Using Triple-Contrast (Oral, IV & Rectal)
  • All Suspected Should Undergo Rigid Proctoscopy
    • *May Miss Extraperitoneal Injuries without Endoscopy

Treatment of Intraperitoneal Injuries

  • Treated Similar to Bowel
  • Non-Destructive: Primary Repair
  • Destructive: Resection – LAR
    • Diverting Ileostomy if Low (High Risk for Leak)

Treatment of Extraperitoneal Injuries

  • High: Same as Intraperitoneal
  • Low-Middle: Primary Repair (If Able) & Diverting Colostomy
    • Repair Attempted through a Transanal Approach
    • Loop Sigmoid Colostomy Generally Preferred – Consider End Colostomy for Devastating Injuries
    • Can Take Down in 6-8 Weeks
  • Historical Considerations:
    • *Presacral Drainage (Previously Recommended for Extraperitoneal Injuries) is Inadequate & Should Not Be Pursued
    • *Distal Rectal Washout is Outdated & May Actually Increase the Risk of Infectious Complications

Rectal Perforation with Contrast Extravasation 3

Rectal Perforation on Endoscopy 4

References

  1. Hefny AF, Al-Ashaal YI, Bani-Hashem AM, Abu-Zidan FM. Seatbelt syndrome associated with an isolated rectal injury: case report. World J Emerg Surg. 2010 Feb 4;5(1):4. (License: CC BY-2.0)
  2. Coskun A, Erkan N, Yakan S, Yıldirim M, Cengiz F. Management of rectal foreign bodies. World J Emerg Surg. 2013 Mar 13;8(1):11. (License: CC BY-2.0)
  3. Hefny AF, Salim EA, Bashir MO, Abu-Zidan FM. An unusual stab wound to the buttock. J Emerg Trauma Shock. 2013 Oct;6(4):298-300. (License: CC BY-NC-SA-3.0)
  4. Sileri P, Del Vecchio Blanco G, Benavoli D, Gaspari AL. Iatrogenic rectal perforation during operative colonoscopy: closure with endoluminal clips. JSLS. 2009 Jan-Mar;13(1):69-72. (License: CC BY-NC-ND-3.0)