1000 Colon Poster
ANO-RECTAL TRAUMA - LOCAL EXPERIENCE
1Y. Khromov, 1L. Koltun, 1J. Sayfan, 2B. Rappaport
1
Department of Surgery A, Haemek Medical Center, Afula
2
Faculty of Medicine, Technion, Haifa, Israel
Background: Civilian ano-rectal injuries are uncommon and treatment is
based on military surgery practice. The applicability of some of these wartime principles to civilian wounds is recently questioned and controversy
exists.
Aim: We present our experience with ano-rectal trauma in recent years. The
mechanism and anatomic features of the injuries were defined, and the
diagnostic work-up as well as treatment modalities were reviewed. Based on
our experience, we address the controversial management issues.
Patients and Methods: Fifteen patients with ano-rectal injuries were
identified. Mean age was 48.4 years (range 12 – 81) and there were 10
males and 5 females. These patients also had multiple associated injuries –
vascular, urinary, intestinal, hepatic, diaphragmatic and neurologic.
Results: In our series majority of injuries were penetrating (73%), however
in 20% of cases the mechanism of trauma was blunt. We classified the rectal
injuries as intra-peritoneal and extra-peritoneal, as accepted, but anoperineal wounds as a separate entity. Wide range of diagnostic means and
treatment modalities were used. Mean hospital stay was 15 days (range 134). Complications included abdominal wound disruption in 2 cases (15%)
and one death due to massive PE (6.6%). There were neither septic
complications nor failure of reconstructive procedures.
Conclusions: Anal and perineal wounds should be viewed as a separate
entity. Loop colostomy provides adequate diversion and if feasible is
advantageous as compared to end colostomy. Distal rectal washout is
superfluous. Damage control staged approach to sphincter mechanism
reconstruction may be used in "devastating" ano-rectal injuries. Clear-cut
management algorithms and guidelines are not available due to relative
rareness of these injuries and the surgical approach should be individually
"tailored" in each case.