Management of Post-Traumatic Posterior Rectal Pouch Through a Posterior Approach

Sameh Hany Emile,Waleed Thabet,Mohammad Fathy

doi:10.24983/scitemed.acri.2018.00081

Abstract

Proximal fecal diversion is the treatment of choice in the cases of extra-peritoneal rectal injuries that are not amenable for primary repair due to their distant location or high grade. The posterior approach enables complete excision of well-defined abscess cavities that communicate with the rectal lumen with full-thickness repair of the rectal defect. An important privilege of pouch excision through the posterior approach was the preservation of rectal reservoir and the sensation that would have been compromised if proctectomy with coloanal anastomosis was alternatively performed.

Highlights

Penetrating rectal injuries are considered one of the important challenges for colorectal surgeons
The proximal diversion prevented further fecal contamination of this abscess cavity allowing it to become encompassed with a layer of fibrous tissue, and converting it to a pseudo-pouch connected to the rectum through the site of rectal perforation
Two options were available for the treatment of this low-lying posterior rectal pouch: either through a trans-abdominal approach and performing a formal low anterior resection with coloanal anastomosis, or through a posterior approach and excising the pouch at its neck with repair of the resultant rectal defect

Summary

Introduction

Penetrating rectal injuries are considered one of the important challenges for colorectal surgeons. A recent multi-institutional study [8] found that the presacral drainage and rectal washout were independently associated with a three-fold increase in abdominal complications, recommending to avoid these measures in the management of extraperitoneal rectal injuries. The present report describes the management of a delayed complication of penetrating extra-peritoneal rectal injury that is presacral abscess cavity communicating with the rectal lumen creating a pseudo-pouch. Examination under anesthesia revealed a 5 cm defect in the posterior rectal wall, around two inches above the anal verge This rectal defect was connected with a large pouch filled with pus and granulation tissue, with the upper part of the pouch lying behind the sacrum. A written informed consent for publishing this case report was obtained from the patient

Findings

Discussion

Conclusion