Weinberg et al described an algorithm for management of penetrating rectal trauma. Appropriate management can significantly reduce complications. The authors are from the University of Tennessee Health Science Center.
The first step is to classify the anatomic location of the penetrating injury.
|
Rectal Wall |
Upper Two Thirds |
Lower Third |
|
anterior wall |
intra-peritoneal |
extra-peritoneal |
|
lateral walls |
intra-peritoneal |
extra-peritoneal |
|
posterior wall |
extra-peritoneal |
extra-peritoneal |
If there are multiple rectal injuries the category is based on the most distal site of injury.
Parameters:
(1) peritoneal location (intra vs extra)
(2) location (upper two thirds vs lower third)
(3) accessibility
|
Peritoneal |
Location |
Accessibility |
Management |
|
intra |
NA |
NA |
primary repair preferred; may require resection and colostomy (diversion) |
|
extra |
upper two thirds |
NA |
primary repair OR (resection and anastomosis); proximal diversion may be done at surgeon's discretion |
|
extra |
lower third |
accessible |
primary repair and proximal diversion |
|
extra |
lower third |
inaccessible |
presacral drainage and proximal diversion |
where:
• A resection with colostomy may be required for intraperitoneal wounds if the patient has a destructive lesion with serious comorbidities or >= 7 units of blood transfused.
Specialty: Surgery, orthopedic, Emergency Medicine, Critical Care, Surgery, general, Gastroenterology
ICD-10: ,
