[Penetrating injuries of the rectum and anus: primary management, reconstruction, rehabilitation].
In adults direct trauma to the anus and rectum originates mostly from gun shots, road traffic accidents, autoeroticism or sexual abuse. Real "impalement" injuries have been frequently seen only in children. As in any polytraumatized patient primary diagnostic procedure--after adequate resuscitation of the patient--consists of X-ray and ultrasound. The patient should be examined in the OR under general anaesthesia and placed in lithotomy position. Treatment often requires a multidisciplinary approach. Primary surgical therapy consists of 4 D's: debridement, drainage, diversion and distal irrigation. No primary reconstructive surgery should be tried. After recovery of the patient dedicated functional testing has do be done prior to reconstructive measures which include sphincter reconstruction. With this concept mortality is low, but functional outcome is variable.
Jehle
E C
EC
Chirurgische Universitätsklinik, Hoppe-Seyler-Strasse 3, 72076 Tübingen.
D000328:Adult; D001003:Anal Canal / Q000293:injuries* / Q000601:surgery; D002648:Child; D005260:Female; D006801:Humans; D008297:Male; D010348:Patient Care Team; D011379:Prognosis; D012007:Rectum / Q000293:injuries* / Q000601:surgery; D012086:Reoperation; D014950:Wounds, Penetrating / Q000209:etiology / Q000601:surgery*