Surgical Management and Associated Complications of Penetrating Rectal Injuries Sustained in Iraq and Afghanistan

Brown, Shaun R.; Swisher, Jonathan P.; Hofmann, Luke J.; Coviello, L.; Davis, Kurt G.

doi:10.7205/milmed-d-13-00167

Cited by 12 publications

(13 citation statements)

References 17 publications

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“…The same results come from Brown et al, who studied 57 patients with penetrating rectal injury sustained in Iraq and Afghanistan [20]. Complications were found in 21% of patients, but logistical regression failed to show a correlation between these complications and presacral drainage ( p = 0.9) and distal washout ( p = 0.33) [20]. We think that in anorectal avulsions with severe perineal soft tissue destructions, presacral drainage should be used, having significant clinical benefits.…”

Section: Discussionsupporting

confidence: 57%

“…The only randomized controlled trial, addressing the penetrating rectal injuries, concluded that presacral drainage had no effect on infectious complications [19]. The same results come from Brown et al, who studied 57 patients with penetrating rectal injury sustained in Iraq and Afghanistan [20]. Complications were found in 21% of patients, but logistical regression failed to show a correlation between these complications and presacral drainage ( p = 0.9) and distal washout ( p = 0.33) [20].…”

Section: Discussionmentioning

confidence: 95%

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Complex Perineal Trauma with Anorectal Avulsion

Cruceru

Negoi

Păun

et al. 2016

Case Reports in Surgery

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Introduction. The objective of this case report is to illustrate a severe perineal impalement injury, associated with anorectal avulsion and hemorrhagic shock. Results. A 32-year-old male patient was referred to our hospital for an impalement perineal trauma, associated with complex pelvic fracture and massive perineal soft tissue destruction and anorectal avulsion. On arrival, the systolic blood pressure was 85 mm Hg and the hemoglobin was 7.1 g/dL. The patient was transported to the operating room, and perineal lavage, hemostasis, and repacking were performed. After 12 hours in the Intensive Care Unit, the abdominal ultrasonography revealed free peritoneal fluid. We decided emergency laparotomy, and massive hemoperitoneum due to intraperitoneal rupture of pelvic hematoma was confirmed. Pelvic packing controlled the ongoing diffuse bleeding. After 48 hours, the relaparotomy with packs removal and loop sigmoid colostomy was performed. The postoperative course was progressive favorable, with discharge after 70 days and colostomy closure after four months, with no long-term complications. Conclusions. Severe perineal injuries are associated with significant morbidity and mortality. Their management in high volume centers, with experience in colorectal and trauma surgery, allocating significant human and material resources, decreases the early mortality and long-term complications, offering the best quality of life for patients.

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Section: Discussionsupporting

confidence: 57%

Section: Discussionmentioning

confidence: 95%

Complex Perineal Trauma with Anorectal Avulsion

Cruceru

Negoi

Păun

et al. 2016

Case Reports in Surgery

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“…Fecal diversion, presacral drainage, repair of injuries, and distal irrigation are principles derived from wartime experi ences from World War I through the Vietnam War.I-4'10,11 Civilian studies after the Vietnam War challenged all aspects of dogmatic treatment including need for fecal diversion, repair of the rectal injury, distal rectal irrigation, and presacral drainage.6'712 Management of rectal injury in the current con flicts has been limited to very small series.13'14 A review of the Joint Theater Trauma Registry from the recent conflicts in Afghanistan and Iraq supported questioning the practice of presacral drainage and washout in the war-injured soldiers. 15 Our study represents the largest series of war-injured rectal injury patients since the Vietnam conflict, and management of these patients was compared to recent civilian trauma series.…”

Section: Discussionmentioning

confidence: 99%

Diversion Remains the Standard of Care for Modern Management of War-Related Rectal Injuries

et al. 2014

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“…Logistic regression analysis was performed to attempt to identify a relationship between these interventions and presence or absence of a complication. Neither was shown to be statistically significant; therefore, the authors concluded that neither distal washout nor presacral drainage added any benefit to the treatment of high-velocity extraperitoneal rectal injuries [16].…”

Section: Extraperitoneal Injuriesmentioning

confidence: 92%

“…Proximal diversion was used around the time of World War I, followed by the addition of presacral drainage during World War II. Distal washout was then implemented during the Vietnam War [16]. This combination of treatment strategies remained the gold standard of care for rectal injuries until the 1990s when studies began challenging the benefit of these interventions [2•].…”

Section: Rectal Injuriesmentioning

confidence: 99%

Penetrating Injuries to the Colon and Rectum

Trust

Brown

2015

Curr Trauma Rep

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The management of colon and rectal injuries has evolved greatly over the last several decades. Once known to have significant mortality, the implementation of mandatory diversion in the 1940s drastically improved outcomes. Since then, treatment strategies have now shifted towards primary repair as a safe option for the majority of injuries. When wounds are more destructive, resection and primary anastomosis are usually appropriate in most situations. Management of penetrating colon injuries is more complex in the setting of damage control surgery and may require difficult decisions regarding timing of anastomosis. Rectal injuries were also historically known to have significant morbidity until diversion was implemented. Extraperitoneal injuries are still treated in a similar fashion, while intraperitoneal injuries are managed using the same principles as colon injuries. This article will review the management of penetrating colon and rectal injuries with focus on literature that has been published over the last 3 years.

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Surgical Management and Associated Complications of Penetrating Rectal Injuries Sustained in Iraq and Afghanistan

Cited by 12 publications

References 17 publications

Complex Perineal Trauma with Anorectal Avulsion

Complex Perineal Trauma with Anorectal Avulsion

Diversion Remains the Standard of Care for Modern Management of War-Related Rectal Injuries

Penetrating Injuries to the Colon and Rectum

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