Citation

Ahern DP, Kelly ME, Courtney D, Rausa E, Winter DC. Injury 2017; 48(6): 1133-1138.

Affiliation

Department of Colorectal Disease, St. Vincent's University Hospital, Ireland.

Copyright

(Copyright © 2017, Elsevier Publishing)

DOI

10.1016/j.injury.2017.03.002

PMID

28292518

Abstract

INTRODUCTION: Traumatic injuries to the lower gastrointestinal tract (rectum and anus) have been largely reported in the military setting with sparse publications from the civilian setting. Additionally, there remains a lack of international consensus regarding definitive treatment pathways. This systematic review aimed to assess the current literature and propose a standardised treatment algorithm to aid management in the civilian setting.

METHODS: A systematic review of available literature from 1999 to 2016 that was performed. Primary endpoints were the assessment and surgical management of reported rectal and anal trauma.

RESULTS: Seven studies were included in this review, reporting on 1255 patients. 96.3% had rectal trauma and 3.7% had anal trauma. Gunshot wounds are the most common mechanism of injury (46.9%). The overwhelming majority of injuries occurred in males (>85%) and were associated with other pelvic injuries. Surgical management has substantially evolved over the last five decades, with no clear consensus on best management strategies.

CONCLUSION: There remains significant international discrepancy regarding the management of penetrating trauma to the rectum. Key management principals include the varying use of the direct primary closure, faecal diversion, pre-sacral drainage and/or distal rectal washout (rarely used). To date, there is sparse evidence regarding the management of penetrating anal trauma.

Copyright © 2017. Published by Elsevier Ltd.

Language: en

Keywords

Lower gastrointestinal injuries; Outcomes; Surgical management; Trauma