Patrick L Bosarge1, John J Como, Nicole Fox, Yngve Falck-Ytter, Elliott R Haut, Heath A Dorion, Nimitt J Patel, Amy Rushing, Lauren A Raff, Amy A McDonald, Bryce R H Robinson, Gerald McGwin, Richard P Gonzalez. 1. From the Departments of Surgery (P.L.B., L.A.R.), and Epidemiology (G.M.), University of Alabama at Birmingham, Birmingham, Alabama; Department of Surgery (J.J.C., N.J.P., A.A.M.), Metrohealth Medical Center, Case Western Reserve University; and Division of Gastroenterology (Y.F.-Y.), Case Western Reserve University, Case and VA Medical Center, Cleveland; Department of Surgery (H.A.D.), Mercy Health St. Elizabeth Youngstown Hospital, Youngstown; and Department of Surgery (A.R.), Ohio State University Wexner Medical Center, Columbus, Ohio; Department of Surgery (N.F.), Cooper University Health Care, Camden, New Jersey; Department of Surgery (E.R.H.), The Johns Hopkins Hospital, Baltimore, Maryland; Department of Surgery (B.R.H.R.), Harborview Medical Center, University of Washington, Seattle, Washington; and Department of Surgery (R.P.G.), Loyola University Medical Center, Maywood, Illinois.
Abstract
BACKGROUND: The management of penetrating rectal trauma invokes a complex decision tree that advocates the principles of proximal diversion (diversion) of the fecal stream, irrigation of stool from the distal rectum, and presacral drainage based on data from World War II and the Vietnam War. This guideline seeks to define the initial operative management principles for nondestructive extraperitoneal rectal injuries. METHODS: A systematic review of the MEDLINE database using PubMed was performed. The search retrieved English language articles regarding penetrating rectal trauma from January 1900 to July 2014. Letters to the editor, case reports, book chapters, and review articles were excluded. Topics of investigation included the management principles of diversion, irrigation of stool from the distal rectum, and presacral drainage using the GRADE methodology. RESULTS: A total of 306 articles were screened leading to a full-text review of 56 articles. Eighteen articles were used to formulate the recommendations of this guideline. CONCLUSION: This guideline consists of three conditional evidence-based recommendations. First, we conditionally recommend proximal diversion for management of these injuries. Second, we conditionally recommend the avoidance of routine presacral drains and distal rectal washout in the management of these injuries.
BACKGROUND: The management of penetrating rectal trauma invokes a complex decision tree that advocates the principles of proximal diversion (diversion) of the fecal stream, irrigation of stool from the distal rectum, and presacral drainage based on data from World War II and the Vietnam War. This guideline seeks to define the initial operative management principles for nondestructive extraperitoneal rectal injuries. METHODS: A systematic review of the MEDLINE database using PubMed was performed. The search retrieved English language articles regarding penetrating rectal trauma from January 1900 to July 2014. Letters to the editor, case reports, book chapters, and review articles were excluded. Topics of investigation included the management principles of diversion, irrigation of stool from the distal rectum, and presacral drainage using the GRADE methodology. RESULTS: A total of 306 articles were screened leading to a full-text review of 56 articles. Eighteen articles were used to formulate the recommendations of this guideline. CONCLUSION: This guideline consists of three conditional evidence-based recommendations. First, we conditionally recommend proximal diversion for management of these injuries. Second, we conditionally recommend the avoidance of routine presacral drains and distal rectal washout in the management of these injuries.
Authors: Antonio Tarasconi; Gennaro Perrone; Justin Davies; Raul Coimbra; Ernest Moore; Francesco Azzaroli; Hariscine Abongwa; Belinda De Simone; Gaetano Gallo; Giorgio Rossi; Fikri Abu-Zidan; Vanni Agnoletti; Gianluigi de'Angelis; Nicola de'Angelis; Luca Ansaloni; Gian Luca Baiocchi; Paolo Carcoforo; Marco Ceresoli; Alain Chichom-Mefire; Salomone Di Saverio; Federica Gaiani; Mario Giuffrida; Andreas Hecker; Kenji Inaba; Michael Kelly; Andrew Kirkpatrick; Yoram Kluger; Ari Leppäniemi; Andrey Litvin; Carlos Ordoñez; Vittoria Pattonieri; Andrew Peitzman; Manos Pikoulis; Boris Sakakushev; Massimo Sartelli; Vishal Shelat; Edward Tan; Mario Testini; George Velmahos; Imtiaz Wani; Dieter Weber; Walter Biffl; Federico Coccolini; Fausto Catena Journal: World J Emerg Surg Date: 2021-09-16 Impact factor: 5.469
Authors: Luis Guillermo Saldarriaga; Helmer Emilio Palacios-Rodríguez; Luis Fernando Pino; Adolfo González Hadad; Yaset Caicedo; Jessica Capre; Alberto García; Fernando Rodríguez-Holguín; Alexander Salcedo; José Julián Serna; Mario Alain Herrera; Michael W Parra; Carlos A Ordoñez; Abraham Kestenberg-Himelfarb Journal: Colomb Med (Cali) Date: 2021-05-20