P. S. Prakash1, D. Jafari2, R. N. Smith1, C. A. Sims1 1The Hospital Of The University Of Pennsylvania,Division Of Trauma, Surgical Critical Care, And Emergency Surgery,Philadelphia, PA, USA 2The Hospital Of The University Of Pennsylvania,Department Of Emergency Medicine,Philadelphi, PA, USA
Introduction:
Traumatic intraperitoneal rectal injuries can be managed with repair or resection and primary anastomosis similar to colonic injuries, yet controversy still exists at an institutional level on optimal management of such injuries during initial surgical intervention. We sought to characterize the incidence of fecal diversion and the associated morbidity in the management of intraperitoneal rectal injuries.
Methods:
We conducted a retrospective cohort study at a level 1 trauma center using a prospective database from 2005-2015. Adult patients with intraperitoneal rectal injuries after blunt and penetrating trauma were included. Operative procedures were determined after review of electronic reports and clinical characteristics and outcomes were compared between groups using appropriate statistical methods. Significance was defined as p < 0.05.
Results:
Overall, 24 patients were identified to have an intraperitoneal rectal injury in a 10 year period. Mean age was 29.6 years (16-69 range). Twenty-one (87%) were male and 20 (83%) were due to penetrating injury. The mean AIS was 3.58 (SD=0.58) and TRISS 0.9 (SD=0.19). All patients survived to discharge. On presentation, mean GCS was 13.5 (SD=3.4), systolic pressure 129 (SD=27), and temperature 97F (SD=1.5). The mean red blood cells transfused on arrival in the trauma bay was 0.7 units (0-5 range). Twenty-two (92%) had a fecal diversion (FD), while only 2 (8%) had a primary repair (PR). Of those who had FD, 18 (82%) received an end colostomy, 4 (18%) a diverting loop colostomy. Overall, 7 (32%) of patients who underwent FD had a post-operative complication. Seventeen (77%) FDs had a colostomy reversal on separate admission.
Conclusion:
Although the treatment strategy for colorectal trauma has advanced during the last part of the twentieth century, complication rates are high and standard management for colorectal trauma remains a controversial issue. Though the literature suggests that intraperitoneal rectal injuries can effectively be managed by primary repair or resection with primary anastomosis, fecal diversion appears to still dominate management strategies, despite associated morbidity.