Current Management of Rectal Injury

Abstract

Because rectal injury is uncommon in civilian practice, we have extrapolated what we have learned from wartime to civilian practice. Mechanism of injury to the rectum is blunt injury (associated with pelvic fracture), gunshot wound, impalement or foreign body, or blast injury. Associated injuries are vascular, urologic, or pelvic fracture. Digital rectal exam (DRE) is essential in evaluation for potential rectal injury, followed with proctoscopy when blood has been found on DRE. DRE should assess for gross blood, mucosal defects, bony fragments, and sphincter tone. Broad spectrum antibiotics are given intravenously for rectal injury. Management of rectal injury depends upon whether it is intraperitoneal or extraperitoneal rectum. Repair intraperitoneal rectal injury is analogous to the management of colonic injury. Repair extraperitoneal rectal injury only if easily accomplished. Avoid extensive dissection of the extraperitoneal rectum. For more distal extraperitoneal rectal injury, diversion is key. Current data do not support routine distal rectal washout. Consider distal washout in the setting of explosive injury or high velocity penetrating injury. Apply presacral drainage only with low, posterior extraperitoneal rectal injury.