title: A new approach to extraperitoneal rectal injuries: laparoscopy and diverting loop sigmoid colostomy.
abstract: BACKGROUND
  Current management of extraperitoneal rectal injuries involves a laparotomy and diversion of the fecal stream. In this study, we review our experience with laparoscopy and diverting loop sigmoid colostomy without laparotomy in the management of these injuries.
  
  
  METHODS
  All patients admitted to the trauma unit at Groote Schuur Hospital between January 1995 and May 2000 with a rectal injury were evaluated. The presence of a rectal injury was confirmed by rectal examination and proctosigmoidoscopy. Intraperitoneal injuries were excluded by laparoscopy. Only patients who did not have intraperitoneal injuries were included in the study. The patients were then managed with a diverting loop sigmoid colostomy created through an abdominal wall trephine without laparotomy.
  
  
  RESULTS
  Ten patients were included in the study. In eight patients, laparoscopy excluded intraperitoneal injuries. All 10 patients had a diverting loop sigmoid colostomy fashioned. There were no complications related to either the rectal injury or colostomy. Nine stomas have since been closed.
  
  
  CONCLUSIONS
  In patients with isolated extraperitoneal rectal injuries, laparoscopic exclusion of intraperitoneal injuries, followed by a diverting loop sigmoid colostomy, is a feasible option.
authors.affiliation: Provincial Administration of the Western Cape, Department of Surgery, Groote Schuur Hospital, Cape Town, South Africa 7925. navsaria@uctgsh1.uct.ac.za
authors.forename: P H
authors.initials: PH
authors.lastname: Navsaria
authors.forename: R
authors.initials: R
authors.lastname: Graham
authors.forename: A
authors.initials: A
authors.lastname: Nicol
mesh_terms: D000293:Adolescent; D000328:Adult; D000465:Algorithms; D003125:Colostomy / Q000379:methods*; D005260:Female; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D012007:Rectum / Q000293:injuries*