Central Surgical Association| Volume 82, ISSUE 3, P310-313, September 1977

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Abdominoperineal resection in the treatment of devascularizing rectal injuries

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      Local debridment, drainage, and diverting colostomy, with or without primary repair of the rectum, have been considered to be the standard treatment for most rectal injuries, but they are not sufficient for those patients sustaining uncontrollable bleeding or extensive rectal devascularization. This report assessed the indications and results of abdominoperineal resection of the rectum in these patients. Ten patients who were victims of explosive trauma presented with massive perineal injuries and extensive rectal devascularization. Six of these were treated with local debridment of necrotic tissue, pararectal drainage, antibiotics, and colostomy. Five of the six patients initially treated by colostomy died after operation fron hemorrhage or sepsis. The sixth patient, who survived, had an abdominal resection of the rectum performed 5 days after the colostomy for removal of a gangrenous rectum. All five of those who underwent abdominoperineal resection survived (p < 0.01). Increasing violence in the life patterns of modern society enhances the possibility of occurrence of this type of lesion, previously limited to military practice. The need for careful investigation of rectal viability is emphasized. Primary abdominoperineal resection of the rectum is advised when extensive devascularization has occurred.
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        • Allen B.D.
        Penetrating wounds of the rectum: Review of 65 cases.
        Texas Med. 1973; 69: 77
        • Armstrong R.G.
        • Schmitt H.J.
        • Patterson L.T.
        Combat wounds of the extraperitoneal rectum.
        Surgery. 1973; 74: 570
        • Berman A.T.
        • Tom L.
        Traumatic Separation of the pubic symphasis with associated fatal rectal tear. A case report and analysis of mechanism of injury.
        J Trauma. 1974; 14: 1060
        • Boxal T.A.
        • Smart P.J.
        • Griffiths I.D.
        The blood supply of the distal segment of the rectum in anterior resection.
        Br J Surg. 1962; 50: 399
        • Fegiz G.
        • Tonelli F.
        • Rossi P.
        • et al.
        Preservation of the superior hemorrhoidal artery in resection of the colon and rectum.
        Surg Gynecol Obstet. 1976; 143: 919
        • Ganchrow M.I.
        • Laverson Jr., G.S.
        • McNamara J.J.
        Surgical management of traumatic injuries of the colon and rectum.
        Arch Surg. 1970; 100: 515
        • Gustavson R.G.
        Rectal injuries.
        Am Surg. 1973; 39: 456
        • Lavenson G.S.
        • Cohen A.C.
        Management of rectal injuries.
        Am J Surg. 1971; 122: 226
        • Lung J.A.
        • Turk R.P.
        • Miller R.E.
        • et al.
        Wounds of the rectum.
        Ann Surg. 1970; 172: 985