Civilian rectal trauma: A changing perspective

Background. Recently the organ Injury Scaling Committee of the American Ass ociation for the Surgery of Trauma developed a Rectal Injury Scaling System (RISS). Little data exist regarding its clinical utility. Methods. We retrospectively reviewed 45 patients with rectal injuries to as sess the impact of the RISS on. patient management and outcome. We compared RISS grade I patients (group I, partial-thickness injury) with patients wi th grades 2, 3, and 4 injuries (group II, full-thickness injury). Results. Group II underwent distal rectal washout and repair of the injury twice as often and had a significantly higher rate of diversion of the feca l stream. This was associated with a 3-fold increase in complications. The only complications in group I were in patients managed with diversion of th e fecal stream and distal rectal washout. Conclusions. Our data suggest that aggressive surgical management for RISS grade I injury may not be necessary. Implementation of therapy based on the RISS may improve outcomes of civilian rectal trauma.