1. Rectal injuries are becoming a major cause of death in India and can result from penetrating or blunt trauma. 2. The rectum has distinct anatomical regions and injuries are classified based on their depth and circumference according to the American Association for the Surgery of Trauma scale. 3. Treatment depends on whether the injury is intraperitoneal or extraperitoneal and may involve fecal diversion, distal washout, drainage, debridement, and repair or reconstruction of damaged sphincters. Accurate diagnosis and classification is important to guide appropriate surgical management of rectal injuries.

1. RECTAL INJURIES
Dr Pravin Hector John
Dr John Thanakumar

2. WHO
INJURY WILL BE THE 3RD CAUSE OF DEATH IN INDIA BY 2020

3. ANATOMY of RECTUM
Rectum surrounded by muscles/bones
Length of rectum 12-15 cm
Upper, middle, lower
Peritoneum covers upper 2/3
Lower third exztraperitoneal
6 cm above anus is peritoneal reflection

4. ETIOLOGY
PENETRATING BLUNT IATROGENIC
BULL GORE
FIREARMS
IMPALEMENT
RTA
MAJOR TRAUMA
OBS, GYNE
UROLOGICAL
ORTHOPEDIC
COLONOSCOPIC
ENEMAS
FOREIGN BODIES

5. 1. DIVERSION OF FAECES, URINE
2. DISTAL RECTAL WASHOUT
3. DRAINAGE OF PRESACRAL SPACE
4. DEBRIDE AND CLOSURE
PRINCIPLES OF TREATMENT

6. DIAGNOSIS
• History
• Physical - Rectal exam
Sphincter tone
Proctoscopy
• Imaging: Plain Xrays
CT scans
MRI identifies cut ends of muscles

7. MRI identifies the sphincters

8. AAST RECTAL INJURY SCALE
Grade I
a) Contusion, hematoma, no devascularization
b) Partial thickness laceration
Grade 2 Laceration < 50% circumference
Grade 3 Laceration >50% circumference
Grade 4 Full thickness laceration with extension into perineum
Grade 5 Devascularized segment
American Association for the Surgery of Trauma (AAST)

9. ROCHE Classification
1 Intraperitoneal perforation - No sphincter damage
2 Intraperitoneal perforation - With sphincter damage
3 Extraperitoneal perforation - No sphincter damage
4 Extraperitoneal perforation - With sphincter damage

10. Treatment- Intraperitoneal Injuries
Treatment is similar to left colonic injury with primary repair
with or without the need for colostomy

11. Treatment -Extraperitoneal Injury
Main factors include:
A. Divert with loop or end colostomy
B. Drainage presacral space
C. Distal rectal washout
D. Debridement and Repair

12. Sphincteric Injury
Primary Repair: Accurate identification and reconstruction of
the ruptured external sphincter with suturing. Colostomy may
or may not be indicated.
Secondary Repair: Repair later on with reconstruction such
as gracious muscle transposition. Not ideal situation

13. Management of Complex Perineal Injuries
Resuscitate
Control of Bleeding
Local debridement and wound irrigation. Repeat prn
Antibiotics
Other injuries - Stabilize pelvis
Divert feces / urine
Enteral feeding
Prevent DVT

14. ANURAG HOSPITAL
SOWRIPALAYAM,
COIMBATORE
Tel : 8015087871
www.anuraghospital.com
Thank you!