Management of some extra-peritoneal rectal injuries without fecal diversion may be feasible, but high-quality evidence is still needed

Excerpt

Although relatively rare, traumatic rectal injuries have long been known to have high morbidity and mortality rates, with infectious complications reported up to 19% and mortality rates of up to 11% [1, 2]. Because of the serious nature of these injuries, it is important to attempt to understand and define optimal management strategies. Evidence-based consensus has been difficult to achieve, partially due to the complicated nature of injury location that may affect diagnosis, management, and outcomes—intra-peritoneal vs extra-peritoneal vs combined—and the complex options that have been advocated as management strategies over the years, including resection vs primary repair, plus/minus diverting stoma formation, plus/minus distal rectal irrigation, and for extra-peritoneal injuries, plus/minus pre-sacral drainage. In addition, due to the rarity of their occurrence, most previous studies have been limited to small, single-center, retrospective reviews. …