Patient selection: trauma to extraperitoneal rectum
Reasons to suspect trauma to the rectum:
(1) blood on digital rectal exam
(2) penetrating trauma in region of rectum
(3) air or fluid adjacent to rectum on CT scan
(4) major pelvic fracture
Examinations to detect rectal injury may involve:
(1) examination under anesthesia
(2) endoscopy
(3) laparotomy
Injury to the rectum > 25% of the circumference is termed destructive.
When to consider proximal diversion:
(1) destructive injury to the rectum
(2) nondestructive injury to the rectum if there are concerns
(3) significant blood transfusion
(4) shock
(5) pancreatic or genitourinary injuries
(6) major chronic illness
(7) immunosuppression
When to consider draining of the perirectal space:
(1) destructive injury to the rectum
(2) blood, fluid or air trapped in the extraperitoneal perirectal space
(3) diagnosis of rectal injury made at laparotomy
