Simplified management of low-energy projectile extraperitoneal rectal injuries.
BACKGROUND
Since minimally invasive approach for fecal diversion in low-velocity extraperitoneal rectal injuries (EPRI) has a lower morbidity than open, and since computed tomography (CT) scan is helpful in ruling out concomitant intraperitoneal injuries (IPI), we utilized both modalities to simplify management of such injuries.


METHODS
Retrospective review of stable patients with EPRI, treated with laparoscopic assisted diversion, after a CT scan, compared with patients with similar injuries that had a negative laparotomy and a colostomy.


RESULTS
The laparoscopy group had a shorter length of stay (3 +/- 2 days versus 7 +/- 2 days), earlier return of bowel function (3 +/- 2 days versus 5 +/- 2 days) and fewer infectious complications. If the CT scan was negative for IPI, none were found on open exploration or laparoscopy.


CONCLUSIONS
If IPI are ruled out with a preoperative CT scan, laparoscopy-assisted colostomy is safe and less morbid.
Ahmed
Naveed
N
Department of Surgery, Huron Hospital, East Cleveland, Ohio, USA. nahmed@cchseast.org
Thekkeurumbil
Sanjay
S
Mathavan
Viney
V
Janzen
Mark
M
Tasse
James
J
Chung
Raphael
R
D003125:Colostomy; D003287:Contrast Media / Q000008:administration & dosage; D006801:Humans; D010535:Laparoscopy; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D011183:Postoperative Complications; D012007:Rectum / Q000000981:diagnostic imaging / Q000293:injuries* / Q000601:surgery*; D012189:Retrospective Studies; D018709:Statistics, Nonparametric; D014057:Tomography, X-Ray Computed; D014948:Wounds, Gunshot / Q000000981:diagnostic imaging / Q000601:surgery*
D003287:Contrast Media