TY - JOUR
T1 - Diversion remains the standard of care for modern management of war-related rectal injuries
AU - O'Donnell, Mary T.
AU - Greer, Lauren T.
AU - Nelson, Jeffery
AU - Shriver, Craig
AU - Vertrees, Amy
N1 - Publisher Copyright:
© 2014 Association of Military Surgeons of the US. All rights reserved.
PY - 2014
Y1 - 2014
N2 - Introduction: Management of rectal injuries in war-injured patients has evolved over time. Methods: Retrospective review of records of patients sustaining war-related rectal injuries admitted to Walter Reed Army Medical Center from Iraq and Afghanistan. Results: From 2003 to 2011, 67 males ages 18 to 40 sustained rectal injuries after secondary blast (64%), gunshot (33%), motor vehicle crash (1%), or helicopter crash (1%). Injuries were extraperitoneal (72%), intraperitoneal (25%), or both (3%). Rectal abbreviated injury score mean was 3 ± 1. Surgical management included end colostomy (66%), loop colostomy (28%), and no diversion (4%). Distal washout (24%) and drain placement (33%) were performed. Colostomy closure occurred in 79% of patients at an average of 237 days after injury. Conclusions: Diversion is the preferred treatment of war-related rectal injuries. Loop colostomy is acceptable unless there is potential for evolving rectal injury. Routine use of presacral irrigation and drainage was not supported.
AB - Introduction: Management of rectal injuries in war-injured patients has evolved over time. Methods: Retrospective review of records of patients sustaining war-related rectal injuries admitted to Walter Reed Army Medical Center from Iraq and Afghanistan. Results: From 2003 to 2011, 67 males ages 18 to 40 sustained rectal injuries after secondary blast (64%), gunshot (33%), motor vehicle crash (1%), or helicopter crash (1%). Injuries were extraperitoneal (72%), intraperitoneal (25%), or both (3%). Rectal abbreviated injury score mean was 3 ± 1. Surgical management included end colostomy (66%), loop colostomy (28%), and no diversion (4%). Distal washout (24%) and drain placement (33%) were performed. Colostomy closure occurred in 79% of patients at an average of 237 days after injury. Conclusions: Diversion is the preferred treatment of war-related rectal injuries. Loop colostomy is acceptable unless there is potential for evolving rectal injury. Routine use of presacral irrigation and drainage was not supported.
UR - http://www.scopus.com/inward/record.url?scp=84928539473&partnerID=8YFLogxK
U2 - 10.7205/MILMED-D-13-00533
DO - 10.7205/MILMED-D-13-00533
M3 - Article
C2 - 25003864
AN - SCOPUS:84928539473
SN - 0026-4075
VL - 179
SP - 778
EP - 782
JO - Military Medicine
JF - Military Medicine
IS - 7
ER -