1Associate Specialist,Department of Colorectal Surgery, Royal Free London NHS Foundation Trust, UK
2Consultant General Surgeon, Aga Khan University Hospital Karachi, Pakistan
3Medical Student, Aga Khan University Hospital Karachi, Pakistan
4Consultant Vascular Surgeon, Aga Khan University Hospital Karachi, Pakistan
5Associate Professor Trauma Surgery, Aga Khan University Hospital Karachi, Pakistan
*Corresponding author: Noman Shahzad, Consultant General Surgeon, Aga Khan University Hospital Karachi
Submission: April 26, 2018;Published: May 03, 2018
ISSN: 2578-0379Volume1 Issue4
Fifteen Years Experience of Managing Penetrating Extra-peritoneal Rectal Injuries.
Background: Although civilian injuries are generally less severe, they nevertheless remain a challenging problem for the surgeons. In isolated rectal injury patients, though proximal diversion, pre-sacral drainage, distal rectal wash-out and wound debridement are the various surgical options employed in various combinations, the optimum strategy especially for civilian injuries remains unknown. We reviewed our experience of managing penetrating extra peritoneal rectal injuries.
Methods: We conducted a Retrospective review of Adult patients with penetrating extra-peritoneal rectal injuries. Follow-up information of at least one month was needed for early post-operative complications.
Results: A total number of fifteen patients met inclusion criteria. Median age of our patients was 46 years with range being 20-80 years. All our patients were males. Thirteen of our patients (86%) suffered from gunshot injury while one was a blast victim and one had a stab injury to rectum. Nine patients (60%) had pelvic fracture associated with rectal injury.
Diversion stoma was made in all of our patients. Overall post-operative morbidity was 40%. Two patients developed necrotizing fasciitis and required repeated debridements followed by graft placement and one patient developed intra-abdominal abscess which was treated by radiological guided drain placement and antibiotics.
Conclusion: Drainage with fecal diversion is the most commonly employed management of extra-peritoneal rectal injuries. Delayed or inadequate drainage can lead to disastrous consequences including necrotizing fasciitis, intra-abdominal abscess.
Keywords: Extra-peritoneal rectal injury; Penetrating trauma; Diversion colostomy; Necrotizing fasciitis.