Penetrating rectal trauma

Management by anatomic distinction improves outcome

Jordan A. Weinberg, Timothy C. Fabian, Louis J. Magnotti, Gayle Minard, Tiffany K. Bee, Norma Edwards, Jeffery A. Claridge, Martin Croce, David H. Livingston, Kimberly A. Davis

Research output: Contribution to journalArticle

42 Citations (Scopus)

Abstract

Background: Controversy persists regarding the optimal management of penetrating rectal injuries, specifically with respect to the routine application of diversion and presacral drainage. Our previous experience suggested that management decisions based on precise anatomic characterization of injury relative to retroperitoneal involvement might improve outcome. A clinical pathway was developed and implemented. Patients managed by the pathway (PATH) were compared with the previous study (PREV, n = 58) to determine the impact of the clinical pathway on outcome. Methods: Consecutive patients with full-thickness penetrating rectal injury subsequent to the development of the pathway were evaluated. Intraperitoneal rectal injuries (IP) were treated with primary repair. Injuries to the proximal two-thirds and accessible distal one-third of the extraperitoneal rectum (EP) were treated with repair and selective fecal diversion. Inaccessible distal EP injuries were treated with diversion and presacral drainage. Infectious complications (wound infection, bacteremia, intraabdominal abscess, retroperitoneal abscess) were compared between the PATH and PREV groups. Results: In all, 54 patients were identified. Demographics, injury severity, and preventive antibiotics (24-hour) were similar between groups. Overall infectious complication rate was 13% in the PATH group versus 31% in the PREV group (p < 0.05). There was a zero incidence of retrorectal abscess in the PATH group versus 11% of the total complications in the PREV group. Conclusions: Implementation of the pathway resulted in a significant decrease in infectious morbidity. Management by anatomic distinction allows for omission of colostomy in most IP injuries and select EP injuries, while diminishing the risk of retrorectal abscess in EP injuries with the judicious application of presacral drainage.

Original languageEnglish (US)
Pages (from-to)508-514
Number of pages7
JournalJournal of Trauma - Injury, Infection and Critical Care
Volume60
Issue number3
DOIs
StatePublished - Mar 1 2006

Fingerprint

Wounds and Injuries
Rectum
Abscess
Drainage
Critical Pathways
Colostomy
Wound Infection
Bacteremia
Demography
Anti-Bacterial Agents
Morbidity
Incidence

All Science Journal Classification (ASJC) codes

  • Surgery
  • Critical Care and Intensive Care Medicine

Cite this

Weinberg, J. A., Fabian, T. C., Magnotti, L. J., Minard, G., Bee, T. K., Edwards, N., ... Davis, K. A. (2006). Penetrating rectal trauma: Management by anatomic distinction improves outcome. Journal of Trauma - Injury, Infection and Critical Care, 60(3), 508-514. https://doi.org/10.1097/01.ta.0000205808.46504.e9

Penetrating rectal trauma : Management by anatomic distinction improves outcome. / Weinberg, Jordan A.; Fabian, Timothy C.; Magnotti, Louis J.; Minard, Gayle; Bee, Tiffany K.; Edwards, Norma; Claridge, Jeffery A.; Croce, Martin; Livingston, David H.; Davis, Kimberly A.

In: Journal of Trauma - Injury, Infection and Critical Care, Vol. 60, No. 3, 01.03.2006, p. 508-514.

Research output: Contribution to journalArticle

Weinberg, JA, Fabian, TC, Magnotti, LJ, Minard, G, Bee, TK, Edwards, N, Claridge, JA, Croce, M, Livingston, DH & Davis, KA 2006, 'Penetrating rectal trauma: Management by anatomic distinction improves outcome', Journal of Trauma - Injury, Infection and Critical Care, vol. 60, no. 3, pp. 508-514. https://doi.org/10.1097/01.ta.0000205808.46504.e9
Weinberg, Jordan A. ; Fabian, Timothy C. ; Magnotti, Louis J. ; Minard, Gayle ; Bee, Tiffany K. ; Edwards, Norma ; Claridge, Jeffery A. ; Croce, Martin ; Livingston, David H. ; Davis, Kimberly A. / Penetrating rectal trauma : Management by anatomic distinction improves outcome. In: Journal of Trauma - Injury, Infection and Critical Care. 2006 ; Vol. 60, No. 3. pp. 508-514.
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AU - Bee, Tiffany K.

AU - Edwards, Norma

AU - Claridge, Jeffery A.

AU - Croce, Martin

AU - Livingston, David H.

AU - Davis, Kimberly A.

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