Anorectal Trauma

ABSTRACT

Fortunately, anorectal trauma is an infrequent occurrence in the civilian population. Most of what is known about the surgical management has been gleaned from experiences in recent combat history. Advances in the surgical and medical care of these patients have decreased the mortality from 100% in early experience to less than 10% in modern times. The mechanisms of anorectal trauma range from simple impalement to high-velocity gunshot wounds, and the spectrum of current management reflects this variation. The gold standard has been intestinal diversion, primary rectal repair, distal rectal washout, and presacral drainage. The management of civilian wounds has evolved, and controversy now exists as to the need for each of these maneuvers. An approach based on mechanism and degree of tissue destruction, location of injury, and associated organ involvement is now advocated. An increasingly common type of anorectal trauma results from rectal foreign bodies. Adherence to management principles maximizes results.

KEYWORD

Rectal - trauma - anorectal trauma

REFERENCES

• 1 Wanebo H J, Hunt T K, Mathewson C. Rectal injuries.  J Trauma . 1969;  9 712-722
• 2 Trunkey D, Hays R J, Shires G T. Management of rectal trauma.  J Trauma . 1973;  13 411-415
• 3 Armstrong R G, Schmitt H J, Patterson L T. Combat wounds of the extraperitoneal rectum.  Surgery . 1973;  74 570-574
• 4 Lavenson G S, Cohen A. Management of rectal injuries.  Am J Surg . 1971;  122 226-230
• 5 Levy R D, Strauss P, Aladgem D. Extraperitoneal rectal gunshot injuries.  J Trauma . 1995;  38 273-277
• 6 Burch J M, Feliciano D V, Mattox K. Colostomy and drainage for civilian rectal injuries: Is that all?.  Ann Surg . 1989;  209 600-611
• 7 Thomas D D, Levison M A, Dykstra B J, Bender J S. Management of rectal injuries. Dogma versus practice.  Am Surg . 1990;  56 507-510
• 8 Mangiante E C, Graham A D, Fabian T C. Rectal gunshot wounds-management of civilian injuries.  Am Surg . 1986;  52 37-40
• 9 Moore E E, Cogbill T H, Malangoni M A. Organ injury scaling, II: pancreas, duodenum, small bowel, colon and rectum.  J Trauma . 1990;  30 1427-1429
• 10 Berne J D, Velmahos G C, Chan L S. The high morbidity of colostomy closure after trauma: further support for the primary repair of colon injuries.  Surgery . 1998;  123 157-164
• 11 Levine J H, Longo W E, Pruitt C. Management of selected rectal injuries by primary repair.  Am J Surg . 1996;  172 575-579
• 12 McGrath V, Fabian T C, Croce M A. Rectal trauma: management based on anatomic considerations.  Am Surg . 1998;  64 1136-1141
• 13 Morris D M, Rayburn D. Loop colostomies are totally diverting in adults.  Am J Surg . 1991;  161 668-671
• 14 Fontes B, Fontes W, Utiyama E M. The efficacy of loop colostomy for complete fecal diversion.  Dis Colon Rectum . 1988;  31 298-302
• 15 Renz B M, Feliciano D V, Sherman R. Same admission colostomy closure (SACC): a new approach to rectal wounds: a prospective study.  Ann Surg . 1993;  218 279-293
• 16 Schultz S C, Magnant C M, Richman M F. Identifying the low-risk patient with penetrating colonic injury for selective use of primary repair.  Surgery . 1993;  177 237-242
• 17 Stone H H, Fabian T C. Colon trauma: further support for primary repair.  Am J Surg . 1979;  290 430-433
• 18 Sasaki L S, Allaban R D, Golwala R. Primary repair of colon injuries: a prospective randomized study.  J Trauma . 1995;  39 895-901
• 19 Tuggle D, Huber P J. Management of rectal trauma.  Am J Surg . 1984;  148 806-808
• 20 Velmahos G C, Gomez H, Falabella A, Demetriades D. Operative management of civilian rectal gunshot wounds: simpler is better.  World J Surg . 2000;  24 114-118
• 21 Franko E R, Ivatury R R, Schwab D M. Combined penetrating rectal and genitourinary injuries: a challenge in management.  J Trauma . 1993;  134 347-353
• 22 Shannon F L, Moore E E, Moore F A. Value of distal colon washout in civilian rectal trauma: reducing gut bacterial translocation.  J Trauma . 1988;  28 989-994
• 23 Gonzalez R P, Falimirski M E, Holevar M R. The role of presacral drainage in the management of penetrating rectal injuries.  J Trauma . 1998;  45 656-661
• 23a Ivatury R R, Licata J, Gunduz Y, Rao P, Stahl W M. Management options in penetrating rectal injuries.  Am Surg . 1991;  57 50-55
• 24 Steinig J P, Boyd C R. Presacral drainage in penetrating extraperitoneal rectal injuries: is it necessary?.  Am Surg . 1996;  62 765-767
• 25 Engel A F, Kamm M A, Hawley P R. Civilian and war injuries of the perineum and anal sphincters.  Br J Surg . 1994;  81 1069-1073
• 26 Sardinha T C, Beck D E. Anorectal Trauma. In: Beck DE, Wexner SD, eds. Fundamentals of Anorectal Surgery, 2nd ed London: WB Saunders 1998: 451-466
• 27 Koplatadze A M, Bondarev I A. Injuries and foreign bodies of the rectum.  Khirurgia . 1990;  9 53-56
• 28 Hicks T C, Opelka F G. The hazards of anal sexual eroticism.  Perspect Colon Rectal Surg . 1994;  7 37-57
• 29 Nehme-Kingsley A, Abcarian H. Colorectal foreign bodies-management update.  Dis Colon Rectum . 1985;  28 941-944