Outcomes of Civilian Penetrating Rectal Injuries Associated With Genitourinary and Bony Injuries.

Abstract

Background: Combined rectal, bladder, and bone injuries are rare but associated with significant morbidity. This study aims to evaluate the outcomes of such injuries.

Methods: A retrospective review of patient records was conducted for all individuals with full thickness penetrating rectal injuries admitted to the Trauma Centre at Groote Schuur Hospital between January 2010 and December 2019. Intraperitoneal rectal injuries were repaired, whereas extraperitoneal rectal injuries were left untreated, with a diverting loop colostomy performed. Intraperitoneal bladder injuries were repaired, whereas extraperitoneal bladder injuries were repaired through cystostomy. Pelvic and spinal fractures were irrigated, but presacral drainage and distal rectal washouts were not performed. Infectious complications and mortality were documented.

Results: A total of 104 patients with 134 rectal injuries were identified (10 intraperitoneal, 64 extraperitoneal, and 30 combined injuries). Genitourinary tract injuries were identified in 42 (40.38%) patients, and 50 patients (48.08%) had associated bone injuries, including sacral (22), iliac (9), pubic rami (5), coccygeal (1), acetabular (3), femoral (6), and pelvic joint (5) fractures. A total of 91 diverting loop colostomies and three Hartmann's procedures were performed. Nine fistulae (6.7%) were observed, including three rectocutaneous, three rectovesical, one small bowel cutaneous, one vesicocutaneous, and one enteroenteric. There were 27 infectious complications, including 13 surgical site infections, 2 cases of pelvic osteitis, and 12 soft tissue infections.

Conclusion: Extraperitoneal rectal injuries with associated bladder and/or bone injuries can be safely managed with fecal diversion, extraperitoneal bladder repair through cystostomy, and irrigation of bone and joint injuries, with minimal morbidity.