Operative treatment of rectal injuries according to the localization of injury

Abstract

Purpose: Controversy still persists regarding the management of rectal injuries. In this study we intend to discuss a selective approach to rectal injuries according to their localization.

Patients and Methods: A retrospective analysis of patients with full-thickness rectal injuries managed between 2000 and 2008 was carried out. Etiology, localization, extent of trauma, and treatment modalities were reviewed.

Results: Seventeen patients were included in the study. The mechanisms of injuries were penetrating in 12 patients [gunshot (n=7) and stab (n=5)], blunt in three patients, iatrogenic in one patient and foreign body in one patient. Concomitantly, other organ injuries were present in eight (47%) patients. The extraperitoneal wounds (n=12) were managed with colostomy (6), colostomy and transabdominal repair (3), transanal repair (2) and transanal repair with presacral drainage (1). Combined intra- and extraperitoneal lesions (n=1) were treated with colostomy only, whereas intraperitoneal lesions (n=4) were managed with colostomy (1) and transabdominal primary repair (3). Presacral drainage was added to colostomy and primary repair in only three patients. Morbidity occurred in three (17.8%) patients. There was no death.

Conclusion: We concluded that most of the intraperitoneal localized rectum injuries can be managed by primary repair alone. Extraperitoneal wounds should be managed by colostomy with primary repair of rectum, when possible. Presacral drainage was added to colostomy in destructive or late extraperitoneal wounds.