title: The management of penetrating rectal and anal trauma: A systematic review.
abstract: BACKGROUND
  Traumatic injuries to the lower gastrointestinal tract (rectum and anus) have been largely reported in the military setting with sparse publications from the civilian setting. Additionally, there remains a lack of international consensus regarding definitive treatment pathways. This systematic review aimed to assess the current literature and propose a standardised treatment algorithm to aid management in the civilian setting.
  
  
  METHODS
  A systematic review of available literature from 1999 to 2016 that was performed. Primary endpoints were the assessment and surgical management of reported rectal and anal trauma.
  
  
  RESULTS
  Seven studies were included in this review, reporting on 1255 patients. 96.3% had rectal trauma and 3.7% had anal trauma. Gunshot wounds are the most common mechanism of injury (46.9%). The overwhelming majority of injuries occurred in males (>85%) and were associated with other pelvic injuries. Surgical management has substantially evolved over the last five decades, with no clear consensus on best management strategies.
  
  
  CONCLUSIONS
  There remains significant international discrepancy regarding the management of penetrating trauma to the rectum. Key management principals include the varying use of the direct primary closure, faecal diversion, pre-sacral drainage and/or distal rectal washout (rarely used). To date, there is sparse evidence regarding the management of penetrating anal trauma.
authors.affiliation: Department of Colorectal Disease, St. Vincent's University Hospital, Ireland. Electronic address: daniel.ahern@umail.ucc.ie.
authors.forename: Daniel P
authors.initials: DP
authors.lastname: Ahern
authors.affiliation: Department of Colorectal Disease, St. Vincent's University Hospital, Ireland.
authors.forename: Michael E
authors.initials: ME
authors.lastname: Kelly
authors.affiliation: Department of Colorectal Disease, St. Vincent's University Hospital, Ireland.
authors.forename: Danielle
authors.initials: D
authors.lastname: Courtney
authors.affiliation: Department of Colorectal Disease, St. Vincent's University Hospital, Ireland.
authors.forename: Emanuele
authors.initials: E
authors.lastname: Rausa
authors.affiliation: Department of Colorectal Disease, St. Vincent's University Hospital, Ireland.
authors.forename: Des C
authors.initials: DC
authors.lastname: Winter
mesh_terms: D000465:Algorithms; D001003:Anal Canal / Q000293:injuries* / Q000503:physiopathology / Q000601:surgery*; D002985:Clinical Protocols; D013505:Digestive System Surgical Procedures; D004322:Drainage / Q000379:methods; D004635:Emergency Medicine; D005242:Fecal Incontinence / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D010533:Peritoneal Lavage / Q000379:methods; D017410:Practice Guidelines as Topic; D011351:Proctoscopy / Q000379:methods; D012007:Rectum / Q000293:injuries* / Q000503:physiopathology / Q000601:surgery*; D014950:Wounds, Penetrating / Q000503:physiopathology / Q000601:surgery*
keywords: Lower gastrointestinal injuries; Outcomes; Surgical management; Trauma