Skip to main content
PMC home page
Annals of Surgery logoLink to Annals of Surgery
. 1989 May;209(5):600–611. doi: 10.1097/00000658-198905000-00013

Colostomy and drainage for civilian rectal injuries: is that all?

J M Burch 1, D V Feliciano 1, K L Mattox 1
PMCID: PMC1494065  PMID: 2705824

Abstract

One hundred consecutive patients with injuries to the extraperitoneal rectum were treated over a ten-year period at an urban trauma center. The mechanisms of injury included firearms in 82 patients, stab wounds in 3 patients, a variety of other penetrating injuries in 10 patients, and in 5 patients the injuries resulted from blunt trauma. Treatment of the rectal injury was determined by the bias of the operating surgeon, the condition of the patient, and the magnitude of the rectal injury. Proximal loop colostomies were performed in 44 patients, diverting colostomies in 51 patients, Hartmann's procedure in 4 patients, and an abdominoperineal resection in 1 patient. Extraperitoneal rectal perforations were closed in 21 patients and the rectum was irrigated free of feces in 46 patients. Transperineal, presacral drainage was used in 93 patients. Infectious complications potentially related to the management of the rectal wound occurred in 11 patients (11%) and included abdominal or pelvic abscesses (4 patients), wound infections (6 patients), rectocutaneous fistulas (3 patients), and missile tract infections (2 patients). Four patients (4%) died as a result of their injuries. Of the therapeutic options available, statistical analysis revealed that only the failure to drain the presacral space increased the likelihood of infectious complications (p = 0.03); however, as it could not be determined with certainty that the use of, or failure to use, any particular therapeutic option had an effect on the risk of death. It is concluded that colostomy and drainage are the foundations of the successful treatment of civilian injuries to the extraperitoneal rectum. The use of adjuncts such as diverting colostomies, repair of the rectal wound, and irrigation of the rectum has little effect on mortality and morbidity.

Full text

PDF
600

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Armstrong R. G., Schmitt H. J., Jr, Patterson L. T. Combat wounds of the extraperitoneal rectum. Surgery. 1973 Oct;74(4):570–574. [PubMed] [Google Scholar]
  2. Bartizal J. F., Boyd D. R., Folk F. A., Smith D., Lescher T. C., Freeark R. J. A critical review of management of 392 colonic and rectal injuries. Dis Colon Rectum. 1974 May-Jun;17(3):313–318. doi: 10.1007/BF02586972. [DOI] [PubMed] [Google Scholar]
  3. Burch J. M., Brock J. C., Gevirtzman L., Feliciano D. V., Mattox K. L., Jordan G. L., Jr, DeBakey M. E. The injured colon. Ann Surg. 1986 Jun;203(6):701–711. doi: 10.1097/00000658-198606000-00016. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Crass R. A., Tranbaugh R. F., Kudsk K. A., Trunkey D. D. Colorectal foreign bodies and perforation. Am J Surg. 1981 Jul;142(1):85–88. doi: 10.1016/s0002-9610(81)80016-5. [DOI] [PubMed] [Google Scholar]
  5. Feliciano D. V., Gentry L. O., Bitondo C. G., Burch J. M., Mattox K. L., Cruse P. A., Jordan G. L., Jr Single agent cephalosporin prophylaxis for penetrating abdominal trauma. Results and comment on the emergence of the enterococcus. Am J Surg. 1986 Dec;152(6):674–681. doi: 10.1016/0002-9610(86)90447-2. [DOI] [PubMed] [Google Scholar]
  6. Ganchrow M. I., Lavenson G. S., Jr, McNamara J. J. Surgical management of traumatic injuries of the colon and rectum. Arch Surg. 1970 Apr;100(4):515–520. doi: 10.1001/archsurg.1970.01340220191032. [DOI] [PubMed] [Google Scholar]
  7. Grasberger R. C., Hirsch E. F. Rectal trauma. A retrospective analysis and guidelines for therapy. Am J Surg. 1983 Jun;145(6):795–799. doi: 10.1016/0002-9610(83)90143-5. [DOI] [PubMed] [Google Scholar]
  8. Hines J. R. Technique for conversion of a loop colostomy to a diverting colostomy. Surg Gynecol Obstet. 1975 Mar;140(3):433–433. [PubMed] [Google Scholar]
  9. Howell H. S., Bartizal J. F., Freeark R. J. Blunt trauma involving the colon and rectum. J Trauma. 1976 Aug;16(08):624–632. doi: 10.1097/00005373-197608000-00006. [DOI] [PubMed] [Google Scholar]
  10. Lavenson G. S., Cohen A. Management of rectal injuries. Am J Surg. 1971 Aug;122(2):226–230. doi: 10.1016/0002-9610(71)90322-9. [DOI] [PubMed] [Google Scholar]
  11. Lung J. A., Turk R. P., Miller R. E., Eiseman B. Wounds of the rectum. Ann Surg. 1970 Dec;172(6):985–990. doi: 10.1097/00000658-197012000-00009. [DOI] [PMC free article] [PubMed] [Google Scholar]
  12. Mangiante E. C., Graham A. D., Fabian T. C. Rectal gunshot wounds. Management of civilian injuries. Am Surg. 1986 Jan;52(1):37–40. [PubMed] [Google Scholar]
  13. Maull K. I., Sachatello C. R., Ernst C. B. The deep perineal laceration-an injury frequently associated with open pelvic fractures: a need for aggressive surgical management. A report of 12 cases and review of the literature. J Trauma. 1977 Sep;17(9):685–696. [PubMed] [Google Scholar]
  14. McDowell G. C., 2nd, Wise H. A., 2nd Rectal perforation as a complication of urethral instrumentation: 2 case reports. J Urol. 1988 Sep;140(3):605–606. doi: 10.1016/s0022-5347(17)41734-4. [DOI] [PubMed] [Google Scholar]
  15. McKenzie A. D., Bell G. A. Nonpenetrating injuries of the colon and rectum. Surg Clin North Am. 1972 Jun;52(3):735–746. doi: 10.1016/s0039-6109(16)39746-8. [DOI] [PubMed] [Google Scholar]
  16. Rombeau J. L., Wilk P. J., Turnbull R. B., Jr, Fazio V. W. Total fecal diversion by the temporary skin-level loop transverse colostomy. Dis Colon Rectum. 1978 May-Jun;21(4):223–226. doi: 10.1007/BF02586696. [DOI] [PubMed] [Google Scholar]
  17. Saltzstein R. J., Quebbeman E., Melvin J. L. Anorectal injuries incident to enema administration. A recurring avoidable problem. Am J Phys Med Rehabil. 1988 Aug;67(4):186–188. doi: 10.1097/00002060-198808000-00010. [DOI] [PubMed] [Google Scholar]
  18. Shannon F. L., Moore E. E., Moore F. A., McCroskey B. L. Value of distal colon washout in civilian rectal trauma--reducing gut bacterial translocation. J Trauma. 1988 Jul;28(7):989–994. doi: 10.1097/00005373-198807000-00013. [DOI] [PubMed] [Google Scholar]
  19. Strate R. G., Grieco J. G. Blunt injury to the colon and rectum. J Trauma. 1983 May;23(5):384–388. doi: 10.1097/00005373-198305000-00005. [DOI] [PubMed] [Google Scholar]
  20. Trunkey D., Hays R. J., Shires G. T. Management of rectal trauma. J Trauma. 1973 May;13(5):411–415. doi: 10.1097/00005373-197305000-00002. [DOI] [PubMed] [Google Scholar]
  21. Tuggle D., Huber P. J., Jr Management of rectal trauma. Am J Surg. 1984 Dec;148(6):806–808. doi: 10.1016/0002-9610(84)90442-2. [DOI] [PubMed] [Google Scholar]
  22. Vitale G. C., Richardson J. D., Flint L. M. Successful management of injuries to the extraperitoneal rectum. Am Surg. 1983 Mar;49(3):159–162. [PubMed] [Google Scholar]
  23. Wanebo H. J., Hunt T. K., Mathewson C., Jr Rectal injuries. J Trauma. 1969 Aug;9(8):712–722. doi: 10.1097/00005373-196908000-00009. [DOI] [PubMed] [Google Scholar]

Articles from Annals of Surgery are provided here courtesy of Lippincott, Williams, and Wilkins

RESOURCES