Outcomes and management of rectal injuries in children

In the pediatric population, rectal injuries usually occur as a result of motor vehicle collisions. There has been an increased interest in selective diversion of rectal injuries in adults and increased utilization of laparoscopy both as a diagnostic and therapeutic adjunct. The aim of the study was to review our institutional experience with rectal injuries to determine if there was a subset of patients who could be managed with selective diversion. The medical records of children admitted with a rectal injury to Hospital for Sick Children, Toronto, over the last 20 years (1984–2004) were retrospectively reviewed. Data abstraction included patient demographics, mechanism of injury, injury severity score, associated injuries, presenting symptoms, methods of diagnosis, treatment and resultant complications. Nine patients with rectal injuries were identified. The average injury severity score (ISS) was 19.3. Two patients with penetrating injuries underwent laparoscopy. Laparoscopy was able to define the intraperitoneal extension of injuries and guide the colostomy. Primary repair without a diverting colostomy was performed in 3 patients (2 intraperitoneal and 1 extraperitoneal injury) without complications. Based on the limited sample size, one should avoid making any definitive recommendations but, it appears, primary repair without fecal diversion can be performed safely in select children in spite of a longer time to surgery. Laparoscopy may be used for the immediate management of the penetrating trauma patient to rule out intraperitoneal extension, repair a perforation and guide the colostomy if necessary.