title: Penetrating bladder trauma: a high risk factor for associated rectal injury.
abstract: Demographics and mechanisms were analyzed in prospectively maintained level one trauma center database 1990-2012. Among 2,693 trauma laparotomies, 113 (4.1%) presented bladder lesions; 51.3% with penetrating injuries (n = 58); 41.3% (n = 24) with rectal injuries, males corresponding to 95.8%, mean age 29.8 years; 79.1% with gunshot wounds and 20.9% with impalement; 91.6% arriving the emergence room awake (Glasgow 14-15), hemodynamically stable (average systolic blood pressure 119.5 mmHg); 95.8% with macroscopic hematuria; and 100% with penetrating stigmata. Physical exam was not sensitive for rectal injuries, showing only 25% positivity in patients. While 60% of intraperitoneal bladder injuries were surgically repaired, extraperitoneal ones were mainly repaired using Foley catheter alone (87.6%). Rectal injuries, intraperitoneal in 66.6% of the cases and AAST-OIS grade II in 45.8%, were treated with primary suture plus protective colostomy; 8.3% were sigmoid injuries, and 70.8% of all injuries had a minimum stool spillage. Mean injury severity score was 19; mean length of stay 10 days; 20% of complications with no death. Concomitant rectal injuries were not a determinant prognosis factor. Penetrating bladder injuries are highly associated with rectal injuries (41.3%). Heme-negative rectal examination should not preclude proctoscopy and eventually rectal surgical exploration (only 25% sensitivity).
authors: Division of Trauma Surgery, Faculty of Medical Sciences, University of Campinas (UNICAMP), 13083-887 Campinas, SP, Brazil.
authors: B M
authors: BM
authors: Pereira
authors: Division of Urology, Faculty of Medical Sciences, University of Campinas (UNICAMP), Rua Tessália Vieira de Camargo 126, Cidade Universitária "Zeferino Vaz," 13083-887 Campinas, SP, Brazil ; Faculty of Medicine, Pontifical Catholic University of Campinas (PUC), 13083-887 Campinas, SP, Brazil.
authors: L O
authors: LO
authors: Reis
authors: Division of Trauma Surgery, Faculty of Medical Sciences, University of Campinas (UNICAMP), 13083-887 Campinas, SP, Brazil.
authors: T R
authors: TR
authors: Calderan
authors: Department of Surgery, Faculty of Medical Sciences, University of Campinas (UNICAMP), 13083-887 Campinas, SP, Brazil.
authors: C C
authors: CC
authors: de Campos
authors: Division of Trauma Surgery, Faculty of Medical Sciences, University of Campinas (UNICAMP), 13083-887 Campinas, SP, Brazil.
authors: G P
authors: GP
authors: Fraga