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Management of civilian penetrating rectal injuries in an urban trauma centre
Background: Rectal injuries are associated with significant morbidity. Primary repair of extraperitoneal rectal injuries, presacral drainage (PSD) and distal rectal washout (DRW) have become historical adjuncts. Aim: A retrospective review was performed to determine the outcome of rectal injuries in...
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| Format: | Thesis |
| Language: | English English |
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Division of General Surgery
2025
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| _version_ | 1867613276672622592 |
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| access_status_str | Open Access |
| author | Govender, Terron |
| author2 | Navsaria, Pradeep |
| author_browse | Govender, Terron Navsaria, Pradeep |
| author_facet | Navsaria, Pradeep Govender, Terron |
| author_sort | Govender, Terron |
| collection | Thesis |
| description | Background: Rectal injuries are associated with significant morbidity. Primary repair of extraperitoneal rectal injuries, presacral drainage (PSD) and distal rectal washout (DRW) have become historical adjuncts. Aim: A retrospective review was performed to determine the outcome of rectal injuries in an urban trauma centre with a high incidence of penetrating trauma where a simple surgical management approach to these injuries is practiced. Methods: The records of all patients with a full-thickness penetrating rectal injury admitted to the Trauma Centre at Groote Schuur Hospital over a 10-year period (January 2010 – December 2019) were reviewed. Basic demographics, injury mechanism and perioperative management, anatomical site of the rectal injury, associated intra-abdominal injuries and their management were recorded. Infectious complications and mortality were noted. Intraperitoneal rectal injuries were primarily repaired, with or without faecal diversion. Extraperitoneal rectal injuries were generally left untouched, and a diverting loop colostomy done. Intraperitoneal bladder injuries were primarily repaired and extraperitoneal bladder injuries were repaired from within the bladder. Pelvic and spinal fractures were copiously lavaged. Presacral drainage and DRW were not performed. Results: One-hundred and four (101: gunshot; 3: stab) patients with 134 rectal injuries [intraperitoneal (10), extraperitoneal (64), combined (30)] were identified. Transpelvic trajectory was identified in 75 (72.12%) patients. Associated genitourinary tract injuries occurred in 42 (40.38%) patients and included 27 (25.96%) bladder injuries [intraperitoneal (9), extraperitoneal (4), combined (14)] and seven (6.73%) distal ureter injuries. Fifty patients 6 (48.08%) had associated bony injuries: sacrum (22), iliac (9), pubic rami (5), coccyx (1), acetabulum (3), femur (6), vertebral fractures (3) and pelvic joints (5). Eight (7.69%) patients had an associated vascular injury [iliac veins (4), iliac arteries (4)]. Two extraperitoneal rectal injuries were repaired. Diverting loop colostomies (91) and three Hartmann's type procedures were done for the remaining untouched extraperitoneal rectal injuries. None had PSD or DRW. Nine (6.7%) fistulae were recorded: three rectocutaneous, three rectovesical, one small bowel cutaneous, one vesicocutaneous and one entero-enteric. There were 27 infectious complications: surgical site infection (13), iliac blade and sacral osteitis (2), other soft tissue infections (12). Conclusion: Extraperitoneal rectal injuries due to low-velocity trauma can be safely managed by faecal diversion, without repair, DRW and PSD with minimal morbidity. |
| format | Thesis |
| id | oai:open.uct.ac.za:11427/41562 |
| institution | University of Cape Town (South Africa) |
| language | English eng |
| last_indexed | 2026-06-10T12:33:33.643Z |
| license_str | Not specified — see source repository |
| provenance_str_mv | Harvested via OAI-PMH from UCTD — University of Cape Town Open Access Repository |
| publishDate | 2025 |
| publishDateRange | 2025 |
| publishDateSort | 2025 |
| publisher | Division of General Surgery |
| publisherStr | Division of General Surgery |
| record_format | dspace |
| source_str | UCTD — University of Cape Town Open Access Repository |
| spelling | oai:open.uct.ac.za:11427/41562 Management of civilian penetrating rectal injuries in an urban trauma centre Govender, Terron Navsaria, Pradeep Penetrating trauma, rectal injury, bladder injury, extraperitoneal, intraperitoneal Background: Rectal injuries are associated with significant morbidity. Primary repair of extraperitoneal rectal injuries, presacral drainage (PSD) and distal rectal washout (DRW) have become historical adjuncts. Aim: A retrospective review was performed to determine the outcome of rectal injuries in an urban trauma centre with a high incidence of penetrating trauma where a simple surgical management approach to these injuries is practiced. Methods: The records of all patients with a full-thickness penetrating rectal injury admitted to the Trauma Centre at Groote Schuur Hospital over a 10-year period (January 2010 – December 2019) were reviewed. Basic demographics, injury mechanism and perioperative management, anatomical site of the rectal injury, associated intra-abdominal injuries and their management were recorded. Infectious complications and mortality were noted. Intraperitoneal rectal injuries were primarily repaired, with or without faecal diversion. Extraperitoneal rectal injuries were generally left untouched, and a diverting loop colostomy done. Intraperitoneal bladder injuries were primarily repaired and extraperitoneal bladder injuries were repaired from within the bladder. Pelvic and spinal fractures were copiously lavaged. Presacral drainage and DRW were not performed. Results: One-hundred and four (101: gunshot; 3: stab) patients with 134 rectal injuries [intraperitoneal (10), extraperitoneal (64), combined (30)] were identified. Transpelvic trajectory was identified in 75 (72.12%) patients. Associated genitourinary tract injuries occurred in 42 (40.38%) patients and included 27 (25.96%) bladder injuries [intraperitoneal (9), extraperitoneal (4), combined (14)] and seven (6.73%) distal ureter injuries. Fifty patients 6 (48.08%) had associated bony injuries: sacrum (22), iliac (9), pubic rami (5), coccyx (1), acetabulum (3), femur (6), vertebral fractures (3) and pelvic joints (5). Eight (7.69%) patients had an associated vascular injury [iliac veins (4), iliac arteries (4)]. Two extraperitoneal rectal injuries were repaired. Diverting loop colostomies (91) and three Hartmann's type procedures were done for the remaining untouched extraperitoneal rectal injuries. None had PSD or DRW. Nine (6.7%) fistulae were recorded: three rectocutaneous, three rectovesical, one small bowel cutaneous, one vesicocutaneous and one entero-enteric. There were 27 infectious complications: surgical site infection (13), iliac blade and sacral osteitis (2), other soft tissue infections (12). Conclusion: Extraperitoneal rectal injuries due to low-velocity trauma can be safely managed by faecal diversion, without repair, DRW and PSD with minimal morbidity. 2025-08-11T06:16:49Z 2025-08-11T06:16:49Z 2025 2025-08-11T06:12:44Z Thesis / Dissertation Masters MMed http://hdl.handle.net/11427/41562 en eng application/pdf Division of General Surgery Faculty of Health Sciences University of Cape Town |
| spellingShingle | Penetrating trauma, rectal injury, bladder injury, extraperitoneal, intraperitoneal Govender, Terron Management of civilian penetrating rectal injuries in an urban trauma centre |
| thesis_degree_str | Master's |
| title | Management of civilian penetrating rectal injuries in an urban trauma centre |
| title_full | Management of civilian penetrating rectal injuries in an urban trauma centre |
| title_fullStr | Management of civilian penetrating rectal injuries in an urban trauma centre |
| title_full_unstemmed | Management of civilian penetrating rectal injuries in an urban trauma centre |
| title_short | Management of civilian penetrating rectal injuries in an urban trauma centre |
| title_sort | management of civilian penetrating rectal injuries in an urban trauma centre |
| topic | Penetrating trauma, rectal injury, bladder injury, extraperitoneal, intraperitoneal |
| url | http://hdl.handle.net/11427/41562 |
| work_keys_str_mv | AT govenderterron managementofcivilianpenetratingrectalinjuriesinanurbantraumacentre |