Contemporary management of rectal injuries at Level i trauma centers: The results of an American Association for the Surgery of Trauma multi-institutional study

Carlos V.R. Brown, Pedro G. Teixeira, Elisa Furay, John P. Sharpe, Tashinga Musonza, John Holcomb, Eric Bui, Brandon Bruns, H. Andrew Hopper, Michael S. Truitt, Clay C. Burlew, Morgan Schellenberg, Jack Sava, John Vanhorn, P. C.Brian Eastridge, Alicia M. Cross, Richard Vasak, Gary - Vercruysse, Eleanor E. Curtis, James HaanRaul Coimbra, Phillip Bohan, Stephen Gale, Peter G. Bendix

Research output: Contribution to journalArticle

8 Citations (Scopus)

Abstract

INTRODUCTION Rectal injuries have been historically treated with a combination of modalities including direct repair, resection, proximal diversion, presacral drainage, and distal rectal washout. We hypothesized that intraperitoneal rectal injuries may be selectively managed without diversion and the addition of distal rectal washout and presacral drainage in the management of extraperitoneal injuries are not beneficial. METHODS This is an American Association for the Surgery of Trauma multi-institutional retrospective study from 2004 to 2015 of all patients who sustained a traumatic rectal injury and were admitted to one of the 22 participating centers. Demographics, mechanism, location and grade of injury, and management of rectal injury were collected. The primary outcome was abdominal complications (abdominal abscess, pelvic abscess, and fascial dehiscence). RESULTS After exclusions, there were 785 patients in the cohort. Rectal injuries were intraperitoneal in 32%, extraperitoneal in 58%, both in 9%, and not documented in 1%. Rectal injury severity included the following grades I, 28%; II, 41%; III, 13%; IV, 12%; and V, 5%. Patients with intraperitoneal injury managed with a proximal diversion developed more abdominal complications (22% vs 10%, p = 0.003). Among patients with extraperitoneal injuries, there were more abdominal complications in patients who received proximal diversion (p = 0.0002), presacral drain (p = 0.004), or distal rectal washout (p = 0.002). After multivariate analysis, distal rectal washout [3.4 (1.4-8.5), p = 0.008] and presacral drain [2.6 (1.1-6.1), p = 0.02] were independent risk factors to develop abdominal complications. CONCLUSION Most patients with intraperitoneal injuries undergo direct repair or resection as well as diversion, although diversion is not associated with improved outcomes. While 20% of patients with extraperitoneal injuries still receive a presacral drain and/or distal rectal washout, these additional maneuvers are independently associated with a three-fold increase in abdominal complications and should not be included in the treatment of extraperitoneal rectal injuries. LEVEL OF EVIDENCE Therapeutic study, level III.

Original languageEnglish (US)
Pages (from-to)225-233
Number of pages9
JournalJournal of Trauma and Acute Care Surgery
Volume84
Issue number2
DOIs
StatePublished - Feb 1 2018

Fingerprint

Trauma Centers
Wounds and Injuries
Drainage
Abdominal Abscess
Abscess

Keywords

  • colostomy
  • presacral drain
  • Rectal trauma
  • rectal washout

ASJC Scopus subject areas

  • Surgery
  • Critical Care and Intensive Care Medicine

Cite this

Contemporary management of rectal injuries at Level i trauma centers : The results of an American Association for the Surgery of Trauma multi-institutional study. / Brown, Carlos V.R.; Teixeira, Pedro G.; Furay, Elisa; Sharpe, John P.; Musonza, Tashinga; Holcomb, John; Bui, Eric; Bruns, Brandon; Hopper, H. Andrew; Truitt, Michael S.; Burlew, Clay C.; Schellenberg, Morgan; Sava, Jack; Vanhorn, John; Eastridge, P. C.Brian; Cross, Alicia M.; Vasak, Richard; Vercruysse, Gary -; Curtis, Eleanor E.; Haan, James; Coimbra, Raul; Bohan, Phillip; Gale, Stephen; Bendix, Peter G.

In: Journal of Trauma and Acute Care Surgery, Vol. 84, No. 2, 01.02.2018, p. 225-233.

Research output: Contribution to journalArticle

Brown, CVR, Teixeira, PG, Furay, E, Sharpe, JP, Musonza, T, Holcomb, J, Bui, E, Bruns, B, Hopper, HA, Truitt, MS, Burlew, CC, Schellenberg, M, Sava, J, Vanhorn, J, Eastridge, PCB, Cross, AM, Vasak, R, Vercruysse, G, Curtis, EE, Haan, J, Coimbra, R, Bohan, P, Gale, S & Bendix, PG 2018, 'Contemporary management of rectal injuries at Level i trauma centers: The results of an American Association for the Surgery of Trauma multi-institutional study', Journal of Trauma and Acute Care Surgery, vol. 84, no. 2, pp. 225-233. https://doi.org/10.1097/TA.0000000000001739
Brown, Carlos V.R. ; Teixeira, Pedro G. ; Furay, Elisa ; Sharpe, John P. ; Musonza, Tashinga ; Holcomb, John ; Bui, Eric ; Bruns, Brandon ; Hopper, H. Andrew ; Truitt, Michael S. ; Burlew, Clay C. ; Schellenberg, Morgan ; Sava, Jack ; Vanhorn, John ; Eastridge, P. C.Brian ; Cross, Alicia M. ; Vasak, Richard ; Vercruysse, Gary - ; Curtis, Eleanor E. ; Haan, James ; Coimbra, Raul ; Bohan, Phillip ; Gale, Stephen ; Bendix, Peter G. / Contemporary management of rectal injuries at Level i trauma centers : The results of an American Association for the Surgery of Trauma multi-institutional study. In: Journal of Trauma and Acute Care Surgery. 2018 ; Vol. 84, No. 2. pp. 225-233.
@article{16afef792f29499282acd3d6b38840e5,
title = "Contemporary management of rectal injuries at Level i trauma centers: The results of an American Association for the Surgery of Trauma multi-institutional study",
abstract = "INTRODUCTION Rectal injuries have been historically treated with a combination of modalities including direct repair, resection, proximal diversion, presacral drainage, and distal rectal washout. We hypothesized that intraperitoneal rectal injuries may be selectively managed without diversion and the addition of distal rectal washout and presacral drainage in the management of extraperitoneal injuries are not beneficial. METHODS This is an American Association for the Surgery of Trauma multi-institutional retrospective study from 2004 to 2015 of all patients who sustained a traumatic rectal injury and were admitted to one of the 22 participating centers. Demographics, mechanism, location and grade of injury, and management of rectal injury were collected. The primary outcome was abdominal complications (abdominal abscess, pelvic abscess, and fascial dehiscence). RESULTS After exclusions, there were 785 patients in the cohort. Rectal injuries were intraperitoneal in 32{\%}, extraperitoneal in 58{\%}, both in 9{\%}, and not documented in 1{\%}. Rectal injury severity included the following grades I, 28{\%}; II, 41{\%}; III, 13{\%}; IV, 12{\%}; and V, 5{\%}. Patients with intraperitoneal injury managed with a proximal diversion developed more abdominal complications (22{\%} vs 10{\%}, p = 0.003). Among patients with extraperitoneal injuries, there were more abdominal complications in patients who received proximal diversion (p = 0.0002), presacral drain (p = 0.004), or distal rectal washout (p = 0.002). After multivariate analysis, distal rectal washout [3.4 (1.4-8.5), p = 0.008] and presacral drain [2.6 (1.1-6.1), p = 0.02] were independent risk factors to develop abdominal complications. CONCLUSION Most patients with intraperitoneal injuries undergo direct repair or resection as well as diversion, although diversion is not associated with improved outcomes. While 20{\%} of patients with extraperitoneal injuries still receive a presacral drain and/or distal rectal washout, these additional maneuvers are independently associated with a three-fold increase in abdominal complications and should not be included in the treatment of extraperitoneal rectal injuries. LEVEL OF EVIDENCE Therapeutic study, level III.",
keywords = "colostomy, presacral drain, Rectal trauma, rectal washout",
author = "Brown, {Carlos V.R.} and Teixeira, {Pedro G.} and Elisa Furay and Sharpe, {John P.} and Tashinga Musonza and John Holcomb and Eric Bui and Brandon Bruns and Hopper, {H. Andrew} and Truitt, {Michael S.} and Burlew, {Clay C.} and Morgan Schellenberg and Jack Sava and John Vanhorn and Eastridge, {P. C.Brian} and Cross, {Alicia M.} and Richard Vasak and Vercruysse, {Gary -} and Curtis, {Eleanor E.} and James Haan and Raul Coimbra and Phillip Bohan and Stephen Gale and Bendix, {Peter G.}",
year = "2018",
month = "2",
day = "1",
doi = "10.1097/TA.0000000000001739",
language = "English (US)",
volume = "84",
pages = "225--233",
journal = "Journal of Trauma and Acute Care Surgery",
issn = "2163-0755",
publisher = "Lippincott Williams and Wilkins",
number = "2",

}

TY - JOUR

T1 - Contemporary management of rectal injuries at Level i trauma centers

T2 - The results of an American Association for the Surgery of Trauma multi-institutional study

AU - Brown, Carlos V.R.

AU - Teixeira, Pedro G.

AU - Furay, Elisa

AU - Sharpe, John P.

AU - Musonza, Tashinga

AU - Holcomb, John

AU - Bui, Eric

AU - Bruns, Brandon

AU - Hopper, H. Andrew

AU - Truitt, Michael S.

AU - Burlew, Clay C.

AU - Schellenberg, Morgan

AU - Sava, Jack

AU - Vanhorn, John

AU - Eastridge, P. C.Brian

AU - Cross, Alicia M.

AU - Vasak, Richard

AU - Vercruysse, Gary -

AU - Curtis, Eleanor E.

AU - Haan, James

AU - Coimbra, Raul

AU - Bohan, Phillip

AU - Gale, Stephen

AU - Bendix, Peter G.

PY - 2018/2/1

Y1 - 2018/2/1

N2 - INTRODUCTION Rectal injuries have been historically treated with a combination of modalities including direct repair, resection, proximal diversion, presacral drainage, and distal rectal washout. We hypothesized that intraperitoneal rectal injuries may be selectively managed without diversion and the addition of distal rectal washout and presacral drainage in the management of extraperitoneal injuries are not beneficial. METHODS This is an American Association for the Surgery of Trauma multi-institutional retrospective study from 2004 to 2015 of all patients who sustained a traumatic rectal injury and were admitted to one of the 22 participating centers. Demographics, mechanism, location and grade of injury, and management of rectal injury were collected. The primary outcome was abdominal complications (abdominal abscess, pelvic abscess, and fascial dehiscence). RESULTS After exclusions, there were 785 patients in the cohort. Rectal injuries were intraperitoneal in 32%, extraperitoneal in 58%, both in 9%, and not documented in 1%. Rectal injury severity included the following grades I, 28%; II, 41%; III, 13%; IV, 12%; and V, 5%. Patients with intraperitoneal injury managed with a proximal diversion developed more abdominal complications (22% vs 10%, p = 0.003). Among patients with extraperitoneal injuries, there were more abdominal complications in patients who received proximal diversion (p = 0.0002), presacral drain (p = 0.004), or distal rectal washout (p = 0.002). After multivariate analysis, distal rectal washout [3.4 (1.4-8.5), p = 0.008] and presacral drain [2.6 (1.1-6.1), p = 0.02] were independent risk factors to develop abdominal complications. CONCLUSION Most patients with intraperitoneal injuries undergo direct repair or resection as well as diversion, although diversion is not associated with improved outcomes. While 20% of patients with extraperitoneal injuries still receive a presacral drain and/or distal rectal washout, these additional maneuvers are independently associated with a three-fold increase in abdominal complications and should not be included in the treatment of extraperitoneal rectal injuries. LEVEL OF EVIDENCE Therapeutic study, level III.

AB - INTRODUCTION Rectal injuries have been historically treated with a combination of modalities including direct repair, resection, proximal diversion, presacral drainage, and distal rectal washout. We hypothesized that intraperitoneal rectal injuries may be selectively managed without diversion and the addition of distal rectal washout and presacral drainage in the management of extraperitoneal injuries are not beneficial. METHODS This is an American Association for the Surgery of Trauma multi-institutional retrospective study from 2004 to 2015 of all patients who sustained a traumatic rectal injury and were admitted to one of the 22 participating centers. Demographics, mechanism, location and grade of injury, and management of rectal injury were collected. The primary outcome was abdominal complications (abdominal abscess, pelvic abscess, and fascial dehiscence). RESULTS After exclusions, there were 785 patients in the cohort. Rectal injuries were intraperitoneal in 32%, extraperitoneal in 58%, both in 9%, and not documented in 1%. Rectal injury severity included the following grades I, 28%; II, 41%; III, 13%; IV, 12%; and V, 5%. Patients with intraperitoneal injury managed with a proximal diversion developed more abdominal complications (22% vs 10%, p = 0.003). Among patients with extraperitoneal injuries, there were more abdominal complications in patients who received proximal diversion (p = 0.0002), presacral drain (p = 0.004), or distal rectal washout (p = 0.002). After multivariate analysis, distal rectal washout [3.4 (1.4-8.5), p = 0.008] and presacral drain [2.6 (1.1-6.1), p = 0.02] were independent risk factors to develop abdominal complications. CONCLUSION Most patients with intraperitoneal injuries undergo direct repair or resection as well as diversion, although diversion is not associated with improved outcomes. While 20% of patients with extraperitoneal injuries still receive a presacral drain and/or distal rectal washout, these additional maneuvers are independently associated with a three-fold increase in abdominal complications and should not be included in the treatment of extraperitoneal rectal injuries. LEVEL OF EVIDENCE Therapeutic study, level III.

KW - colostomy

KW - presacral drain

KW - Rectal trauma

KW - rectal washout

UR - http://www.scopus.com/inward/record.url?scp=85041591742&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85041591742&partnerID=8YFLogxK

U2 - 10.1097/TA.0000000000001739

DO - 10.1097/TA.0000000000001739

M3 - Article

C2 - 29140953

AN - SCOPUS:85041591742

VL - 84

SP - 225

EP - 233

JO - Journal of Trauma and Acute Care Surgery

JF - Journal of Trauma and Acute Care Surgery

SN - 2163-0755

IS - 2

ER -