Diagnostic pelvic computed tomography in the rectal-injured combat casualty.
BACKGROUND
The current standard for evaluating trauma patients for penetrating rectal injury is to perform a rigid proctoscopy. This can be laborious and inaccurate. Injuries are often not visualized and a small number of unnecessary colostomies may be created. Computed tomography (CT) scanning of the pelvis may be useful in identifying penetrating rectal injuries.


METHODS
A retrospective analysis was performed on data regarding all casualties admitted to the 10th Combat Support Hospital during the period of November 2005 through March 2006. Nineteen patients were identified. Patients that were hemodynamically stable underwent preoperative CT scanning. All rectal injuries diagnosed preoperatively were confirmed through a different diagnostic modality in the OR.


RESULTS
Nineteen patients with rectal injury or suspected rectal injury were identified. Eight of the 19 were hemodynamically unstable in the emergency medical treatment area and were taken emergently to surgery. For discussion, only stable patients with gunshot wound or blast/fragmentation injury mechanisms were included. No injuries were missed by CT scanning, but there were two false-positive scans.


CONCLUSIONS
In our brief experience, CT scanning was a useful screening tool to assist in identifying patients with penetrating traumatic rectal injuries. It allowed us to improve triage and make effective use of limited operative resources.
Johnson
Eric K
EK
Department of Surgery, Dwight David Eisenhower Army Medical Center, 300 Hospital Road, Fort Gordon, GA 30905, USA.
Judge
Timothy
T
Lundy
Jonathan
J
Meyermann
Mark
M
D006801:Humans; D008887:Military Medicine; D008889:Military Personnel; D012007:Rectum / Q000293:injuries*; D012189:Retrospective Studies; D014055:Tomography, Emission-Computed; D014218:Triage; D014857:Warfare; D014947:Wounds and Injuries / Q000175:diagnosis*