title: Diversion remains the standard of care for modern management of war-related rectal injuries.
abstract: BACKGROUND
  Management of rectal injuries in war-injured patients has evolved over time.
  
  
  METHODS
  Retrospective review of records of patients sustaining war-related rectal injuries admitted to Walter Reed Army Medical Center from Iraq and Afghanistan.
  
  
  RESULTS
  From 2003 to 2011, 67 males ages 18 to 40 sustained rectal injuries after secondary blast (64%), gunshot (33%), motor vehicle crash (1%), or helicopter crash (1%). Injuries were extraperitoneal (72%), intraperitoneal (25%), or both (3%). Rectal abbreviated injury score mean was 3 ± 1. Surgical management included end colostomy (66%), loop colostomy (28%), and no diversion (4%). Distal washout (24%) and drain placement (33%) were performed. Colostomy closure occurred in 79% of patients at an average of 237 days after injury.
  
  
  CONCLUSIONS
  Diversion is the preferred treatment of war-related rectal injuries. Loop colostomy is acceptable unless there is potential for evolving rectal injury. Routine use of presacral irrigation and drainage was not supported.
authors.affiliation: Walter Reed National Military Medical Center, 8901 Wisconsin Avenue, Bethesda, MD 20814.
authors.forename: Mary T
authors.initials: MT
authors.lastname: O'Donnell
authors.affiliation: Walter Reed National Military Medical Center, 8901 Wisconsin Avenue, Bethesda, MD 20814.
authors.forename: Lauren T
authors.initials: LT
authors.lastname: Greer
authors.affiliation: Walter Reed National Military Medical Center, 8901 Wisconsin Avenue, Bethesda, MD 20814.
authors.forename: Jeffery
authors.initials: J
authors.lastname: Nelson
authors.affiliation: Walter Reed National Military Medical Center, 8901 Wisconsin Avenue, Bethesda, MD 20814.
authors.forename: Craig
authors.initials: C
authors.lastname: Shriver
authors.affiliation: Walter Reed National Military Medical Center, 8901 Wisconsin Avenue, Bethesda, MD 20814.
authors.forename: Amy
authors.initials: A
authors.lastname: Vertrees
mesh_terms: D000007:Abdominal Injuries / Q000601:surgery*; D000328:Adult; D055826:Afghan Campaign 2001-; D013505:Digestive System Surgical Procedures / Q000592:standards*; D006801:Humans; D054542:Iraq War, 2003-2011; D008297:Male; D008887:Military Medicine / Q000592:standards*; D008889:Military Personnel; D012007:Rectum / Q000293:injuries*; D012189:Retrospective Studies; D059039:Standard of Care / Q000458:organization & administration*; D000067398:War-Related Injuries / Q000601:surgery*; D014950:Wounds, Penetrating / Q000601:surgery*