Govender and Madiba developed management algorithms for patients with trauma to the large bowel. These can help to manage these patients more effectively. The authors are from University of KwoZulu-Natal and King Edward VIII Hospital in South Africa.


Management of the patient:

(1) Resuscitate.

(2) Identify colonic injury on laparotomy.

(3) Identify rectal injury in a patient with transpelvic trauma (via proctosigmoidoscopy, laparoscopy, laparotomy or other technique).


Types of injuries:

(1) destructive injuries to the colon

(2) non-destructive injury to the colon

(3) intra-peritoneal rectal injury

(4) extra-peritoneal rectal injury

Type of Injury


destructive injury to colon

resect damaged segment and perform anastomosis

non-destructive injury to the colon

primary repair

intra-peritoneal rectal injury

primary repair and perform anastomosis

extra-peritoneal rectal injury

colostomy with or without peritoneal drain



• The use of a presacral drain for an extraperitoneal rectal injury is controversial.


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