Contemporary diagnosis and management of traumatic rectal injuries

Abstract

Rectal injuries are rare but potentially devastating injuries that are frequently associated with penetrating pelvic trauma or blunt pelvic fractures. Management principles for these injuries have gone through major paradigm shifts over time. Recently, large-scale civilian studies have been completed, providing valuable insight on best-practice strategies for contemporary trauma populations. The diagnosis of rectal injuries is accomplished with a combination of computed tomography (CT) scanning and rigid proctoscopy. Because the rectum is comprised of two distinct anatomic segments, the intra- and extraperitoneal rectum, management principles for rectal injuries are unique. Intraperitoneal rectal injuries are managed as colonic injuries, with small injuries primarily repaired and larger injuries resected. Extraperitoneal injuries are repaired primarily via a trans-anal approach, if feasible, and otherwise are managed with proximal diversion alone. Complications seen after rectal injuries include infection, strictures, and fistulae. The most provocative questions about rectal injuries that are currently unanswered relate to the possibility of nonoperative management for penetrating extraperitoneal rectal injuries and to the optimal timing of colostomy reversal after proximal diversion for extraperitoneal injuries.

Keywords

• Rectal injuries
• Penetrating trauma
• Proctoscopy
• Extraperitoneal rectal trauma
• Proximal diversion
• Colostomy