Penetrating Trans-Anal Rectal Injury, Multiple Case Study

The objective of this study is to evaluate the management of penetrating trans-anal rectal injuries.

Introduction

The rectum is a portion of the large intestine that begins at the recto-sigmoid junction, which is identified anatomically by the coalescence of the tenia coli at the distal sigmoid colon. Distally, the rectum transitions into the anal canal, the rectum is approximately 12–15 cm long and functions in fecal storage prior to defecation. Rectal injuries should be considered in all pelvic trauma patients and managed appropriately.  Colorectal injuries remain a challenging clinical entity associated with significant morbidity. Familiarity with the different methods to approach and manage these injuries, including “damage control” tactics when necessary, will allow surgeons to minimize unnecessary complications and mortality. [1] Rectal injuries due to penetrating trauma are more common than blunt trauma .Early diagnosis and aggressive treatment result in good prognosis, regardless of the patients’ age and previous medical condition. Trans-anal rectal injuries are uncommon. (2).  Surgical repair of rectal injuries was first formally described among World War I soldiers [9], although the adoption of proximal diversion and its association with reduced mortality was not described until World War II [10]. The initial management of all trauma patients should follow the standard ACS Advanced Trauma Life Support (ATLS) guidelines. The diagnosis and initial management of rectal injuries form part of the secondary survey and should only be pursued once immediately life-threatening injuries have been excluded or addressed. The digital rectal exam (DRE) in trauma settings has low sensitivity and does not change subsequent management. Recent civilian evidence suggests that the combination of CT of the abdomen/pelvis and rigid proctoscopy is the new gold-standard for diagnosis of rectal injuries. (42)