Penetrating Trans-Anal Rectal Injury, Multiple Case Study
Article Details
Abstract
The objective of this study is to evaluate the management of penetrating trans-anal rectal injuries.
Introduction
The rectum is a portion of the large intestine that begins at the recto-sigmoid junction, which is identified anatomically by the coalescence of the tenia coli at the distal sigmoid colon. Distally, the rectum transitions into the anal canal, the rectum is approximately 12–15 cm long and functions in fecal storage prior to defecation. Rectal injuries should be considered in all pelvic trauma patients and managed appropriately. Colorectal injuries remain a challenging clinical entity associated with significant morbidity. Familiarity with the different methods to approach and manage these injuries, including “damage control” tactics when necessary, will allow surgeons to minimize unnecessary complications and mortality. [1] Rectal injuries due to penetrating trauma are more common than blunt trauma .Early diagnosis and aggressive treatment result in good prognosis, regardless of the patients’ age and previous medical condition. Trans-anal rectal injuries are uncommon. (2). Surgical repair of rectal injuries was first formally described among World War I soldiers [9], although the adoption of proximal diversion and its association with reduced mortality was not described until World War II [10]. The initial management of all trauma patients should follow the standard ACS Advanced Trauma Life Support (ATLS) guidelines. The diagnosis and initial management of rectal injuries form part of the secondary survey and should only be pursued once immediately life-threatening injuries have been excluded or addressed. The digital rectal exam (DRE) in trauma settings has low sensitivity and does not change subsequent management. Recent civilian evidence suggests that the combination of CT of the abdomen/pelvis and rigid proctoscopy is the new gold-standard for diagnosis of rectal injuries. (42)
Keywords
References
1. Steele, S. R., Maykel, J. A., & Johnson, E. K. (2011). Traumatic injury of the colon and rectum: the evidence vs dogma. Diseases of the colon & rectum, 54(9), 1184-1201.
2. El-Ashaal, Y. I., Al-Olama, A. K., & Abu-Zidan, F. M. (2008). Trans-anal rectal injuries. Singapore Med J, 49(1), 54-56.
3. Brown, S. R., Swisher, J. P., Hofmann, L. J., Coviello, L. C., & Davis, K. G. (2013). Surgical management and associated complications of penetrating rectal injuries sustained in Iraq and Afghanistan. Military medicine, 178(11), 1213-1217.
4. Brown, C. V., Teixeira, P. G., Furay, E., Sharpe, J. P., Musonza, T., Holcomb, J., ... & AAST Contemporary Management of Rectal Injuries Study Group. (2018). Contemporary management of rectal injuries at Level I trauma centers: The results of an American Association for the Surgery of Trauma multi-institutional study. Journal of Trauma and Acute Care Surgery, 84(2), 225-233.
5. Gash, K. J., Suradkar, K., & Kiran, R. P. (2018). Rectal trauma injuries: outcomes from the US National Trauma Data Bank. Techniques in coloproctology, 22(11), 847-855.
6. Velmahos, G. C., Gomez, H., Falabella, A., & Demetriades, D. (2000). Operative management of civilian rectal gunshot wounds: simpler is better. World journal of surgery, 24(1), 114-118.
7. Brown, S. R., Swisher, J. P., Hofmann, L. J., Coviello, L. C., & Davis, K. G. (2013). Surgical management and associated complications of penetrating rectal injuries sustained in Iraq and Afghanistan. Military medicine, 178(11), 1213-1217.
8. Welling, D. R., & Duncan, J. E. (2008). Stomas and trauma. Clinics in colon and rectal surgery, 21(01), 045-052.
9. Fraser, J., & Drummond, H. (1917). A clinical and experimental study of three hundred perforating wounds of the abdomen. British Medical Journal, 1(2932), 321.
10. Demetriades, D. (2004). Colon injuries: new perspectives. Injury, 35(3), 217-222.
11. Lavenson, G. S., & Cohen, A. (1971). Management of rectal injuries. The American Journal of Surgery, 122(2), 226-230.
12. Glasgow, S. C., Steele, S. R., Duncan, J. E., & Rasmussen, T. E. (2012). Epidemiology of modern battlefield colorectal trauma: a review of 977 coalition casualties. Journal of trauma and acute care surgery, 73(6), S503-S508.
13. Steele, S. R., Wolcott, K. E., Mullenix, P. S., Martin, M. J., Sebesta, J. A., Azarow, K. S., & Beekley, A. C. (2007). Colon and rectal injuries during Operation Iraqi Freedom: are there any changing trends in management or outcome? Diseases of the colon & rectum, 50(6), 870-877.
14. Lesperance, K., Martin, M. J., Beekley, A. C., & Steele, S. R. (2008). The significance of penetrating gluteal injuries: an analysis of the Operation Iraqi Freedom experience. Journal of Surgical Education, 65(1), 61-66.
15. Glasgow, S. C., Steele, S. R., Duncan, J. E., & Rasmussen, T. E. (2012). Epidemiology of modern battlefield colorectal trauma: a review of 977 coalition casualties. Journal of trauma and acute care surgery, 73(6), S503-S508.
16. MOOre, E. E. (1990). gbill TH, Malangoni MA, et a1. O~ aranjury Sc 她 Ⅱ: Pancreas, duodentma, Small bow—el, oDrflon and recttma. JT rau—Hla, 30, 1427-1429.
17. Miller, A. H., Brown, C. V., & Martin, M. J. (2019). Anorectal trauma and injuries. In Fundamentals of anorectal surgery (pp. 517-530). Springer, Cham.
18. Weinberg, J. A., Fabian, T. C., Magnotti, L. J., Minard, G., Bee, T. K., Edwards, N., & Croce, M. A. (2006). Penetrating rectal trauma: management by anatomic distinction improves outcome. Journal of Trauma and Acute Care Surgery, 60(3), 508-514.
19. Steele, S. R., Maykel, J. A., & Johnson, E. K. (2011). Traumatic injury of the colon and rectum: the evidence vs dogma. Diseases of the colon & rectum, 54(9), 1184-1201
20. Brown, S. R., Swisher, J. P., Hofmann, L. J., Coviello, L. C., & Davis, K. G. (2013). Surgical management and associated complications of penetrating rectal injuries sustained in Iraq and Afghanistan. Military medicine, 178(11), 1213-1217.
21. Glasgow, S. C., Steele, S. R., Duncan, J. E., & Rasmussen, T. E. (2012). Epidemiology of modern battlefield colorectal trauma: a review of 977 coalition casualties. Journal of trauma and acute care surgery, 73(6), S503-S508.
22. Cho, S. D., Kiraly, L. N., Flaherty, S. F., Herzig, D. O., Lu, K. C., & Schreiber, M. A. (2010). Management of colonic injuries in the combat theater. Diseases of the colon & rectum, 53(5), 728-734.
23. Aihara, R., Blansfield, J. S., Millham, F. H., LaMorte, W. W., & Hirsch, E. F. (2002). Fracture locations influence the likelihood of rectal and lower urinary tract injuries in patients sustaining pelvic fractures. Journal of Trauma and Acute Care Surgery, 52(2), 205-209.
24. Clemens, M. S., Peace, K. M., & Yi, F. (2018). Rectal trauma: evidence-based practices. Clinics in Colon and Rectal Surgery, 31(01), 017-023.
25. Glasgow, S. C., Steele, S. R., Duncan, J. E., & Rasmussen, T. E. (2012). Epidemiology of modern battlefield colorectal trauma: a review of 977 coalition casualties. Journal of trauma and acute care surgery, 73(6), S503-S508.
26. Esposito, T. J., Ingraham, A., Luchette, F. A., Sears, B. W., Santaniello, J. M., Davis, K. A., ... & Gamelli, R. L. (2005). Reasons to omit digital rectal exam in trauma patients: no fingers, no rectum, no useful additional information. Journal of Trauma and Acute Care Surgery, 59(6), 1314-1319.
27. Hargraves, M. B., Magnotti, L. J., Fischer, P. E., Schroeppel, T. J., Zarzaur, B. L., Fabian, T. C., & Croce, M. A. (2009). Injury location dictates utility of digital rectal examination and rigid sigmoidoscopy in the evaluation of penetrating rectal trauma. The American Surgeon, 75(11), 1069-1072.
28. Shlamovitz, G. Z., Mower, W. R., Bergman, J., Crisp, J., DeVore, H. K., Hardy, D., ... & Morgan, M. T. (2007). Poor test characteristics for the digital rectal examination in trauma patients. Annals of emergency medicine, 50(1), 25-33.
29. Johnson, E. K., Judge, T., Lundy, J., & Meyermann, M. (2008). Diagnostic pelvic computed tomography in the rectal-injured combat casualty. Military medicine, 173(3), 293-299.
30. Johnson, E. K., Judge, T., Lundy, J., & Meyermann, M. (2008). Diagnostic pelvic computed tomography in the rectal-injured combat casualty. Military medicine, 173(3), 293-299.
31. Anderson, S. W., & Soto, J. A. (2008, December). Anorectal trauma: the use of computed tomography scan in diagnosis. In Seminars in Ultrasound, CT and MRI (Vol. 29, No. 6, pp. 472-482). WB Saunders.
32. Leaphart, C. L., Danko, M., Cassidy, L., Gaines, B., & Hackam, D. J. (2006). An analysis of proctoscopy vs computed tomography scanning in the diagnosis of rectal injuries in children: which is better?. Journal of pediatric surgery, 41(4), 700-703.
33. Emigh, B., Inaba, K., & Schellenberg, M. (2021). Contemporary diagnosis and management of traumatic rectal injuries. Surgery in Practice and Science, 4, 100024.
34. Schellenberg, M., Inaba, K., Priestley, E. M., Durso, J., Wong, M. D., Lam, L., & Demetriades, D. (2016). The diagnostic yield of commonly used investigations in pelvic gunshot wounds. Journal of Trauma and Acute Care Surgery, 81(4), 692-698.
35. Veith, J., Brown, C. V., Sharpe, J. P., Musonza, T., Holcomb, J., Bui, E., & AAST Contemporary Management of Rectal Injuries Study Group. (2018). Traumatic rectal injuries: Is the combination of computed tomography and rigid proctoscopy sufficient? Journal of Trauma and Acute Care Surgery, 85(6), 1033-1037.
36. Weinberg, J. A., Fabian, T. C., Magnotti, L. J., Minard, G., Bee, T. K., Edwards, N., & Croce, M. A. (2006). Penetrating rectal trauma: management by anatomic distinction improves outcome. Journal of Trauma and Acute Care Surgery, 60(3), 508-514.
37. Arthurs, Z., Kjorstad, R., Mullenix, P., Rush Jr, R. M., Sebesta, J., & Beekley, A. (2006). The use of damage-control principles for penetrating pelvic battlefield trauma. The American journal of surgery, 191(5), 604-609.
38. Paran, H., Butnaru, G., Neufeld, D., Magen, A., & Freund, U. (1999). Enema-induced perforation of the rectum in chronically constipated patients. Diseases of the colon & rectum, 42(12), 1609-1612.
39. Weinberg, J. A., Fabian, T. C., Magnotti, L. J., Minard, G., Bee, T. K., Edwards, N., & Croce, M. A. (2006). Penetrating rectal trauma: management by anatomic distinction improves outcome. Journal of Trauma and Acute Care Surgery, 60(3), 508-514.
40. Brown, S. R., Swisher, J. P., Hofmann, L. J., Coviello, L. C., & Davis, K. G. (2013). Surgical management and associated complications of penetrating rectal injuries sustained in Iraq and Afghanistan. Military medicine, 178(11), 1213-1217.
41. Velmahos, G. C., Gomez, H., Falabella, A., & Demetriades, D. (2000). Operative management of civilian rectal gunshot wounds: simpler is better. World journal of surgery, 24(1), 114-118.
42. Schellenberg, Morgan, et al. "The diagnostic yield of commonly used investigations in pelvic gunshot wounds." Journal of Trauma and Acute Care Surgery 81.4 (2016): 692-698.
43. Davis, J. R., Hale, A. L., & Smith, D. E. (2015). Jet ski hydrostatic perineal injuries from a level I trauma experience. The American Surgeon, 81(7), E282.
44. El-Ashaal, Y. I., Al-Olama, A. K., & Abu-Zidan, F. M. (2008). Trans-anal rectal injuries. Singapore Med J, 49(1), 54-56.
45. Clemens, M. S., Peace, K. M., & Yi, F. (2018). Rectal trauma: evidence-based practices. Clinics in Colon and Rectal Surgery, 31(01), 017-023.
2. El-Ashaal, Y. I., Al-Olama, A. K., & Abu-Zidan, F. M. (2008). Trans-anal rectal injuries. Singapore Med J, 49(1), 54-56.
3. Brown, S. R., Swisher, J. P., Hofmann, L. J., Coviello, L. C., & Davis, K. G. (2013). Surgical management and associated complications of penetrating rectal injuries sustained in Iraq and Afghanistan. Military medicine, 178(11), 1213-1217.
4. Brown, C. V., Teixeira, P. G., Furay, E., Sharpe, J. P., Musonza, T., Holcomb, J., ... & AAST Contemporary Management of Rectal Injuries Study Group. (2018). Contemporary management of rectal injuries at Level I trauma centers: The results of an American Association for the Surgery of Trauma multi-institutional study. Journal of Trauma and Acute Care Surgery, 84(2), 225-233.
5. Gash, K. J., Suradkar, K., & Kiran, R. P. (2018). Rectal trauma injuries: outcomes from the US National Trauma Data Bank. Techniques in coloproctology, 22(11), 847-855.
6. Velmahos, G. C., Gomez, H., Falabella, A., & Demetriades, D. (2000). Operative management of civilian rectal gunshot wounds: simpler is better. World journal of surgery, 24(1), 114-118.
7. Brown, S. R., Swisher, J. P., Hofmann, L. J., Coviello, L. C., & Davis, K. G. (2013). Surgical management and associated complications of penetrating rectal injuries sustained in Iraq and Afghanistan. Military medicine, 178(11), 1213-1217.
8. Welling, D. R., & Duncan, J. E. (2008). Stomas and trauma. Clinics in colon and rectal surgery, 21(01), 045-052.
9. Fraser, J., & Drummond, H. (1917). A clinical and experimental study of three hundred perforating wounds of the abdomen. British Medical Journal, 1(2932), 321.
10. Demetriades, D. (2004). Colon injuries: new perspectives. Injury, 35(3), 217-222.
11. Lavenson, G. S., & Cohen, A. (1971). Management of rectal injuries. The American Journal of Surgery, 122(2), 226-230.
12. Glasgow, S. C., Steele, S. R., Duncan, J. E., & Rasmussen, T. E. (2012). Epidemiology of modern battlefield colorectal trauma: a review of 977 coalition casualties. Journal of trauma and acute care surgery, 73(6), S503-S508.
13. Steele, S. R., Wolcott, K. E., Mullenix, P. S., Martin, M. J., Sebesta, J. A., Azarow, K. S., & Beekley, A. C. (2007). Colon and rectal injuries during Operation Iraqi Freedom: are there any changing trends in management or outcome? Diseases of the colon & rectum, 50(6), 870-877.
14. Lesperance, K., Martin, M. J., Beekley, A. C., & Steele, S. R. (2008). The significance of penetrating gluteal injuries: an analysis of the Operation Iraqi Freedom experience. Journal of Surgical Education, 65(1), 61-66.
15. Glasgow, S. C., Steele, S. R., Duncan, J. E., & Rasmussen, T. E. (2012). Epidemiology of modern battlefield colorectal trauma: a review of 977 coalition casualties. Journal of trauma and acute care surgery, 73(6), S503-S508.
16. MOOre, E. E. (1990). gbill TH, Malangoni MA, et a1. O~ aranjury Sc 她 Ⅱ: Pancreas, duodentma, Small bow—el, oDrflon and recttma. JT rau—Hla, 30, 1427-1429.
17. Miller, A. H., Brown, C. V., & Martin, M. J. (2019). Anorectal trauma and injuries. In Fundamentals of anorectal surgery (pp. 517-530). Springer, Cham.
18. Weinberg, J. A., Fabian, T. C., Magnotti, L. J., Minard, G., Bee, T. K., Edwards, N., & Croce, M. A. (2006). Penetrating rectal trauma: management by anatomic distinction improves outcome. Journal of Trauma and Acute Care Surgery, 60(3), 508-514.
19. Steele, S. R., Maykel, J. A., & Johnson, E. K. (2011). Traumatic injury of the colon and rectum: the evidence vs dogma. Diseases of the colon & rectum, 54(9), 1184-1201
20. Brown, S. R., Swisher, J. P., Hofmann, L. J., Coviello, L. C., & Davis, K. G. (2013). Surgical management and associated complications of penetrating rectal injuries sustained in Iraq and Afghanistan. Military medicine, 178(11), 1213-1217.
21. Glasgow, S. C., Steele, S. R., Duncan, J. E., & Rasmussen, T. E. (2012). Epidemiology of modern battlefield colorectal trauma: a review of 977 coalition casualties. Journal of trauma and acute care surgery, 73(6), S503-S508.
22. Cho, S. D., Kiraly, L. N., Flaherty, S. F., Herzig, D. O., Lu, K. C., & Schreiber, M. A. (2010). Management of colonic injuries in the combat theater. Diseases of the colon & rectum, 53(5), 728-734.
23. Aihara, R., Blansfield, J. S., Millham, F. H., LaMorte, W. W., & Hirsch, E. F. (2002). Fracture locations influence the likelihood of rectal and lower urinary tract injuries in patients sustaining pelvic fractures. Journal of Trauma and Acute Care Surgery, 52(2), 205-209.
24. Clemens, M. S., Peace, K. M., & Yi, F. (2018). Rectal trauma: evidence-based practices. Clinics in Colon and Rectal Surgery, 31(01), 017-023.
25. Glasgow, S. C., Steele, S. R., Duncan, J. E., & Rasmussen, T. E. (2012). Epidemiology of modern battlefield colorectal trauma: a review of 977 coalition casualties. Journal of trauma and acute care surgery, 73(6), S503-S508.
26. Esposito, T. J., Ingraham, A., Luchette, F. A., Sears, B. W., Santaniello, J. M., Davis, K. A., ... & Gamelli, R. L. (2005). Reasons to omit digital rectal exam in trauma patients: no fingers, no rectum, no useful additional information. Journal of Trauma and Acute Care Surgery, 59(6), 1314-1319.
27. Hargraves, M. B., Magnotti, L. J., Fischer, P. E., Schroeppel, T. J., Zarzaur, B. L., Fabian, T. C., & Croce, M. A. (2009). Injury location dictates utility of digital rectal examination and rigid sigmoidoscopy in the evaluation of penetrating rectal trauma. The American Surgeon, 75(11), 1069-1072.
28. Shlamovitz, G. Z., Mower, W. R., Bergman, J., Crisp, J., DeVore, H. K., Hardy, D., ... & Morgan, M. T. (2007). Poor test characteristics for the digital rectal examination in trauma patients. Annals of emergency medicine, 50(1), 25-33.
29. Johnson, E. K., Judge, T., Lundy, J., & Meyermann, M. (2008). Diagnostic pelvic computed tomography in the rectal-injured combat casualty. Military medicine, 173(3), 293-299.
30. Johnson, E. K., Judge, T., Lundy, J., & Meyermann, M. (2008). Diagnostic pelvic computed tomography in the rectal-injured combat casualty. Military medicine, 173(3), 293-299.
31. Anderson, S. W., & Soto, J. A. (2008, December). Anorectal trauma: the use of computed tomography scan in diagnosis. In Seminars in Ultrasound, CT and MRI (Vol. 29, No. 6, pp. 472-482). WB Saunders.
32. Leaphart, C. L., Danko, M., Cassidy, L., Gaines, B., & Hackam, D. J. (2006). An analysis of proctoscopy vs computed tomography scanning in the diagnosis of rectal injuries in children: which is better?. Journal of pediatric surgery, 41(4), 700-703.
33. Emigh, B., Inaba, K., & Schellenberg, M. (2021). Contemporary diagnosis and management of traumatic rectal injuries. Surgery in Practice and Science, 4, 100024.
34. Schellenberg, M., Inaba, K., Priestley, E. M., Durso, J., Wong, M. D., Lam, L., & Demetriades, D. (2016). The diagnostic yield of commonly used investigations in pelvic gunshot wounds. Journal of Trauma and Acute Care Surgery, 81(4), 692-698.
35. Veith, J., Brown, C. V., Sharpe, J. P., Musonza, T., Holcomb, J., Bui, E., & AAST Contemporary Management of Rectal Injuries Study Group. (2018). Traumatic rectal injuries: Is the combination of computed tomography and rigid proctoscopy sufficient? Journal of Trauma and Acute Care Surgery, 85(6), 1033-1037.
36. Weinberg, J. A., Fabian, T. C., Magnotti, L. J., Minard, G., Bee, T. K., Edwards, N., & Croce, M. A. (2006). Penetrating rectal trauma: management by anatomic distinction improves outcome. Journal of Trauma and Acute Care Surgery, 60(3), 508-514.
37. Arthurs, Z., Kjorstad, R., Mullenix, P., Rush Jr, R. M., Sebesta, J., & Beekley, A. (2006). The use of damage-control principles for penetrating pelvic battlefield trauma. The American journal of surgery, 191(5), 604-609.
38. Paran, H., Butnaru, G., Neufeld, D., Magen, A., & Freund, U. (1999). Enema-induced perforation of the rectum in chronically constipated patients. Diseases of the colon & rectum, 42(12), 1609-1612.
39. Weinberg, J. A., Fabian, T. C., Magnotti, L. J., Minard, G., Bee, T. K., Edwards, N., & Croce, M. A. (2006). Penetrating rectal trauma: management by anatomic distinction improves outcome. Journal of Trauma and Acute Care Surgery, 60(3), 508-514.
40. Brown, S. R., Swisher, J. P., Hofmann, L. J., Coviello, L. C., & Davis, K. G. (2013). Surgical management and associated complications of penetrating rectal injuries sustained in Iraq and Afghanistan. Military medicine, 178(11), 1213-1217.
41. Velmahos, G. C., Gomez, H., Falabella, A., & Demetriades, D. (2000). Operative management of civilian rectal gunshot wounds: simpler is better. World journal of surgery, 24(1), 114-118.
42. Schellenberg, Morgan, et al. "The diagnostic yield of commonly used investigations in pelvic gunshot wounds." Journal of Trauma and Acute Care Surgery 81.4 (2016): 692-698.
43. Davis, J. R., Hale, A. L., & Smith, D. E. (2015). Jet ski hydrostatic perineal injuries from a level I trauma experience. The American Surgeon, 81(7), E282.
44. El-Ashaal, Y. I., Al-Olama, A. K., & Abu-Zidan, F. M. (2008). Trans-anal rectal injuries. Singapore Med J, 49(1), 54-56.
45. Clemens, M. S., Peace, K. M., & Yi, F. (2018). Rectal trauma: evidence-based practices. Clinics in Colon and Rectal Surgery, 31(01), 017-023.
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