Daniel P Ahern1, Michael E Kelly2, Danielle Courtney2, Emanuele Rausa2, Des C Winter2. 1. Department of Colorectal Disease, St. Vincent's University Hospital, Ireland. Electronic address: daniel.ahern@umail.ucc.ie. 2. Department of Colorectal Disease, St. Vincent's University Hospital, Ireland.
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.
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.
Authors: Carlos A Ordoñez; Michael W Parra; Yaset Caicedo; Natalia Padilla; Edison Angamarca; José Julián Serna; Fernando Rodríguez-Holguín; Alberto García; Alexander Salcedo; Luis Fernando Pino; Adolfo González-Hadad; Mario Alain Herrera; Laureano Quintero; Fabian Hernández; María Josefa Franco; Gonzalo Aristizábal; Luis Eduardo Toro; Mónica Guzmán-Rodríguez; Federico Coccolini; Ricardo Ferrada; Rao Ivatury Journal: Colomb Med (Cali) Date: 2021-04-27
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