Management of rectal injuries

Abstract

Rectal injuries result from a variety of insults and cause a heterogeneous spectrum of injuries to patients. Historically, many of these injuries were devastating, with high morbidity and mortality. They often required an aggressive approach to treatment including fecal stream diversion, distal rectal washout, and presacral drainage. Contemporary surgical care and a better understanding of the management of these injuries have dramatically improved outcomes. Although aggressive management including diversion is still the gold standard for treatment of severe injuries, some civilian injuries may require less aggressive management, including nonoperative management. By examining most studies published on rectal injuries in the last 50 years, this comprehensive review examines the incidence, demographics, mechanisms, associated injuries, diagnostic methods, and treatment recommendations. Rectal injuries remain a complex and challenging problem for the surgeon, and a thorough understanding of this disease process as well as the treatment options available is necessary to ensure a safe and successful outcome for the patient.