Civilian extraperitoneal rectal gunshot wounds: surgical management made simpler.
BACKGROUND
Rectal injuries are associated with significant morbidity and mortality. Controversy persists regarding routine presacral drainage, distal rectal washout (DRW), and primary repair of extraperitoneal rectal injuries. This retrospective review was performed to determine the outcome of rectal injuries in an urban trauma center with a high incidence of penetrating trauma where a non-aggressive surgical approach to these injuries is practiced.


METHODS
The records of all patients with a full-thickness penetrating rectal injury admitted to the Trauma Center at Groote Schuur Hospital over a 4-year period were reviewed. These were reviewed for demographics, injury mechanism and perioperative management, anatomical site of the rectal injury, associated intra-abdominal injuries and their management. Infectious complications and mortality were noted. Intraperitoneal rectal injuries were primarily repaired, with or without fecal diversion. Extraperitoneal rectal injuries were generally left untouched and a diverting colostomy was done. Presacral drainage and DRW were not routinely performed.


RESULTS
Ninety-two patients with 118 rectal injuries [intraperitoneal (7), extraperitoneal (59), combined (26)] were identified. Only two extraperitoneal rectal injuries were repaired. None had presacral drainage. Eighty-six sigmoid loop colostomies were done. Two (2.2%) fistula, one rectocutaneous, and one rectovesical, were recorded. There were nine (9.9%) infectious complications: surgical site infection (4), buttock abscess (1), buttock necrosis (1), pubic ramus osteitis (1), septic arthritis (2). No perirectal sepsis occurred.


CONCLUSIONS
Extraperitoneal rectal injuries due to low-velocity trauma can be safely managed by fecal diversion alone.
Navsaria
Pradeep H
PH
Trauma Center, Trauma Unit C14 Groote Schuur Hospital, and Faculty of Health Sciences University of Cape Town, Cape Town, South Africa. navsaria@uctgsh1.uct.ac.za
Edu
Sorin
S
Nicol
Andrew J
AJ
D000293:Adolescent; D000328:Adult; D000465:Algorithms; D003125:Colostomy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009104:Multiple Trauma / Q000601:surgery; D010529:Peritoneal Cavity / Q000293:injuries / Q000601:surgery; D011183:Postoperative Complications / Q000209:etiology; D012007:Rectum / Q000293:injuries* / Q000601:surgery; D012189:Retrospective Studies; D013530:Surgical Wound Infection / Q000209:etiology; D014193:Trauma Centers; D016896:Treatment Outcome; D014948:Wounds, Gunshot / Q000601:surgery*