The role of presacral drainage in the management of penetrating rectal injuries

Richard P. Gonzalez, Mark Falimirski, Michele R. Holevar

Research output: Contribution to journalArticle

71 Citations (Scopus)

Abstract

Purpose: To compare in a randomized, prospective manner infectious complication rates associated with presacral drainage versus no drainage in the presence of penetrating rectal injury. Methods: During a 45-month period, 48 patients with penetrating rectal injuries were entered into a randomized, prospective study at an urban Level I trauma center. The patients were randomized to a presacral drainage group or a nondrainage group. Randomization was performed after detection of the rectal injury. Forty-four injuries were identified by proctoscopy (92%), with the rest detected intraoperatively or by physical examination. All patients with rectal injuries were included regardless of age, associated injuries, time from injury to operation, blood loss, severity of rectal injury, other abdominal organs injured, or hemodynamic stability. Rectal injuries were defined as those injuries to the large bowel distal to the peritoneal reflection. All rectal injuries underwent fecal diversion, and all drainage was accomplished using closed Jackson-Pratt drainage. Results: Forty-eight patients were studied, of whom 25 were randomized to no drainage and 23 were randomized to presacral drainage. The average age for the nondrainage group was 21.9 years, and the average age for the presacral drainage group 26.0 years. The average Penetrating Abdominal Trauma Index score was 34.3 for the nondrainage group and 32.4 for the presacral drainage group. There were two (8%) septic complications (one perirectal and one perivesical abscess) associated with the rectal injuries in the presacral drainage group. The abscesses in the drainage group resolved after computed tomography-guided drainage. There was one (4%) septic complication (rectocutaneous fistula) in the nondrainage group, which was associated with a retained missile fragment. The fistula resolved after bedside percutaneous removal of the missile fragment. Conclusion: We conclude that presacral drainage for penetrating rectal injuries has no effect on infectious complications associated with the rectal injuries.

Original languageEnglish (US)
Pages (from-to)656-661
Number of pages6
JournalJournal of Trauma - Injury, Infection and Critical Care
Volume45
Issue number4
DOIs
StatePublished - Oct 1998
Externally publishedYes

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Drainage
Wounds and Injuries
Abscess
Fistula
Proctoscopy
Abdominal Injuries
Trauma Centers
Random Allocation
Physical Examination
Age Groups
Hemodynamics
Tomography
Prospective Studies

ASJC Scopus subject areas

  • Surgery

Cite this

The role of presacral drainage in the management of penetrating rectal injuries. / Gonzalez, Richard P.; Falimirski, Mark; Holevar, Michele R.

In: Journal of Trauma - Injury, Infection and Critical Care, Vol. 45, No. 4, 10.1998, p. 656-661.

Research output: Contribution to journalArticle

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abstract = "Purpose: To compare in a randomized, prospective manner infectious complication rates associated with presacral drainage versus no drainage in the presence of penetrating rectal injury. Methods: During a 45-month period, 48 patients with penetrating rectal injuries were entered into a randomized, prospective study at an urban Level I trauma center. The patients were randomized to a presacral drainage group or a nondrainage group. Randomization was performed after detection of the rectal injury. Forty-four injuries were identified by proctoscopy (92{\%}), with the rest detected intraoperatively or by physical examination. All patients with rectal injuries were included regardless of age, associated injuries, time from injury to operation, blood loss, severity of rectal injury, other abdominal organs injured, or hemodynamic stability. Rectal injuries were defined as those injuries to the large bowel distal to the peritoneal reflection. All rectal injuries underwent fecal diversion, and all drainage was accomplished using closed Jackson-Pratt drainage. Results: Forty-eight patients were studied, of whom 25 were randomized to no drainage and 23 were randomized to presacral drainage. The average age for the nondrainage group was 21.9 years, and the average age for the presacral drainage group 26.0 years. The average Penetrating Abdominal Trauma Index score was 34.3 for the nondrainage group and 32.4 for the presacral drainage group. There were two (8{\%}) septic complications (one perirectal and one perivesical abscess) associated with the rectal injuries in the presacral drainage group. The abscesses in the drainage group resolved after computed tomography-guided drainage. There was one (4{\%}) septic complication (rectocutaneous fistula) in the nondrainage group, which was associated with a retained missile fragment. The fistula resolved after bedside percutaneous removal of the missile fragment. Conclusion: We conclude that presacral drainage for penetrating rectal injuries has no effect on infectious complications associated with the rectal injuries.",
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