title: Fecal continence following complex anorectal trauma in children.
abstract: BACKGROUND
  Complex injuries involving the anus and rectum are uncommon in children. We sought to examine long-term fecal continence following repair of these injuries.
  
  
  METHODS
  We conducted a retrospective review using our trauma registry from 2003 to 2012 of children with traumatic injuries to the anus or rectum at a level I pediatric trauma center. Patients with an injury requiring surgical repair that involved the anal sphincters and/or rectum were selected for a detailed review.
  
  
  RESULTS
  Twenty-one patients (21/13,149 activations, 0.2%) who had an injury to the anus (n=9), rectum (n=8), or destructive injury to both the anus and rectum (n=4) were identified. Eleven (52%) patients were male, and the median age at time of injury was 9 (range 1-14) years. Penetrating trauma accounted for 48% of injuries. Three (14%) patients had accompanying injury to the urinary tract, and 6 (60%) females had vaginal injuries. All patients with an injury involving the rectum and destructive anal injuries were managed with fecal diversion. No patient with an isolated anal injury underwent fecal diversion. Four (19%) patients developed wound infections. The majority (90%) of patients were continent at last follow-up. One patient who sustained a gunshot injury to the pelvis with sacral nerve involvement is incontinent, but remains artificially clean on an intense bowel management program with enemas, and one patient with a destructive crush injury still has a colostomy.
  
  
  CONCLUSIONS
  With anatomic reconstruction of the anal sphincter mechanism, most patients with traumatic anorectal injuries will experience long-term fecal continence. Follow-up is needed as occasionally these patients, specifically those with nerve or crush injury, may require a formal bowel management program.
authors: Division of Pediatric Surgery, Primary Children's Medical Center, University of Utah, Salt Lake City, UT. Electronic address: Katie.Russell@hsc.utah.edu.
authors: Katie W
authors: KW
authors: Russell
authors: Division of Pediatric Surgery, Primary Children's Medical Center, University of Utah, Salt Lake City, UT.
authors: Elizabeth S
authors: ES
authors: Soukup
authors: Division of Pediatric Surgery, Primary Children's Medical Center, University of Utah, Salt Lake City, UT.
authors: Ryan R
authors: RR
authors: Metzger
authors: Division of Pediatric Surgery, Primary Children's Medical Center, University of Utah, Salt Lake City, UT.
authors: Sarah
authors: S
authors: Zobell
authors: Division of Pediatric Surgery, Primary Children's Medical Center, University of Utah, Salt Lake City, UT.
authors: Eric R
authors: ER
authors: Scaife
authors: Division of Pediatric Surgery, Primary Children's Medical Center, University of Utah, Salt Lake City, UT.
authors: Douglas C
authors: DC
authors: Barnhart
authors: Division of Pediatric Surgery, Primary Children's Medical Center, University of Utah, Salt Lake City, UT.
authors: Michael D
authors: MD
authors: Rollins
mesh_terms: D000293:Adolescent; D001003:Anal Canal / Q000293:injuries* / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D013505:Digestive System Surgical Procedures; D005242:Fecal Incontinence / Q000209:etiology*; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D012007:Rectum / Q000293:injuries* / Q000601:surgery*; D012042:Registries; D012189:Retrospective Studies; D012307:Risk Factors; D014193:Trauma Centers; D016896:Treatment Outcome; D014947:Wounds and Injuries / Q000601:surgery*
keywords: Anal injury; Anorectal injury; Colostomy; Impalement; Pediatric trauma; Penetrating trauma; Rectal injury