MANAGEMENT OF EXTRAPERITONEAL RECTAL INJURIES

Twenty-eight consecutive extraperitoneal rectal injuries for a period of 34 months ending in May 1990 were reviewed retrospectively. All inj uries were due to penetrating gunshot wounds. The rectal exam was posi tive in 75% of patients versus 80.8% with proctosigmoidoscopy. All 28 patients had diversion of the fecal stream. Diverting colostomies were performed in 17 patients, Hartmann's colostomies in 7 patients, and p roximal loop colostomies in 4 patients. Presacral drainage was used in 25 patients (89.3%). Distal irrigation was performed in 13 patients ( 46.4%) and primary repair in 9 patients (32.1%). There was one infecti ous complication (3.6%) and no deaths (0%). Fecal diversion and presac ral drainage are the mainstay of therapy for civilian rectal injuries. The importance of distal irrigation of the rectum has not been establ ished. Primary repair of the rectum has no effect on morbidity and mor tality.