Rectal Injury After Foreign Body Insertion: Secondary Analysis From the AAST Contemporary Management of Rectal Injuries Study Group.
Rectal Injury After Foreign Body Insertion: Secondary Analysis From the AAST Contemporary Management of Rectal Injuries Study Group.
- 2020
BACKGROUND: Retained rectal foreign bodies are a common but incompletely studied problem. This study defined the epidemiology, injury severity, and outcomes after rectal injuries following foreign body insertion. CONCLUSIONS: Although partial thickness rectal injuries do not require intervention, difficulty excluding full thickness injuries led some surgeons in this series to manage partial thickness injuries operatively. This was associated with significantly longer hospital length of stay. Therefore, we recommend nonoperative management after a retained rectal foreign body unless full thickness injury is conclusively identified. Copyright (c) 2019 Elsevier Inc. All rights reserved. METHODS: Twenty-two level I trauma centers retrospectively identified all patients sustaining a rectal injury in this AAST multi-institutional trial (2005-2014). Only patients injured by foreign body insertion were included in this secondary analysis. Exclusion criteria were death before rectal injury management or <=48 h of admission. Demographics, clinical data, and outcomes were collected. Study groups were defined as partial thickness (AAST grade I) versus full thickness (AAST grades II-V) injuries. Subgroup analysis was performed by management strategy (nonoperative versus operative). RESULTS: After exclusions, 33 patients were identified. Mean age was 41 y (range 18-57), and 85% (n = 28) were male. Eleven (33%) had full thickness injuries and 22 (67%) had partial thickness injuries, of which 14 (64%) were managed nonoperatively and 8 (36%) operatively (proximal diversion alone [n = 3, 14%]; direct repair with proximal diversion [n = 2, 9%]; laparotomy without rectal intervention [n = 2, 9%]; and direct repair alone [n = 1, 5%]). Subgroup analysis of outcomes after partial thickness injury demonstrated significantly shorter hospital length of stay (2 +/- 1; 2 [1-5] versus 5 +/- 2; 4 [2-8] d, P = 0.0001) after nonoperative versus operative management.
English
0022-4804
10.1016/j.jss.2019.09.048 [doi] S0022-4804(19)30693-6 [pii]
*Conservative Treatment/sn [Statistics & Numerical Data]
*Foreign Bodies/co [Complications]
*Rectum/in [Injuries]
*Surgical Procedures, Operative/sn [Statistics & Numerical Data]
*Wounds, Nonpenetrating/ep [Epidemiology]
Adolescent
Adult
Female
Foreign Bodies/th [Therapy]
Humans
Injury Severity Score
Length of Stay/sn [Statistics & Numerical Data]
Male
Middle Aged
Rectum/dg [Diagnostic Imaging]
Rectum/su [Surgery]
Retrospective Studies
Trauma Centers/sn [Statistics & Numerical Data]
Treatment Outcome
Wounds, Nonpenetrating/di [Diagnosis]
Wounds, Nonpenetrating/et [Etiology]
Wounds, Nonpenetrating/th [Therapy]
Young Adult
MedStar Washington Hospital Center
Surgery/Trauma Surgery
Journal Article
BACKGROUND: Retained rectal foreign bodies are a common but incompletely studied problem. This study defined the epidemiology, injury severity, and outcomes after rectal injuries following foreign body insertion. CONCLUSIONS: Although partial thickness rectal injuries do not require intervention, difficulty excluding full thickness injuries led some surgeons in this series to manage partial thickness injuries operatively. This was associated with significantly longer hospital length of stay. Therefore, we recommend nonoperative management after a retained rectal foreign body unless full thickness injury is conclusively identified. Copyright (c) 2019 Elsevier Inc. All rights reserved. METHODS: Twenty-two level I trauma centers retrospectively identified all patients sustaining a rectal injury in this AAST multi-institutional trial (2005-2014). Only patients injured by foreign body insertion were included in this secondary analysis. Exclusion criteria were death before rectal injury management or <=48 h of admission. Demographics, clinical data, and outcomes were collected. Study groups were defined as partial thickness (AAST grade I) versus full thickness (AAST grades II-V) injuries. Subgroup analysis was performed by management strategy (nonoperative versus operative). RESULTS: After exclusions, 33 patients were identified. Mean age was 41 y (range 18-57), and 85% (n = 28) were male. Eleven (33%) had full thickness injuries and 22 (67%) had partial thickness injuries, of which 14 (64%) were managed nonoperatively and 8 (36%) operatively (proximal diversion alone [n = 3, 14%]; direct repair with proximal diversion [n = 2, 9%]; laparotomy without rectal intervention [n = 2, 9%]; and direct repair alone [n = 1, 5%]). Subgroup analysis of outcomes after partial thickness injury demonstrated significantly shorter hospital length of stay (2 +/- 1; 2 [1-5] versus 5 +/- 2; 4 [2-8] d, P = 0.0001) after nonoperative versus operative management.
English
0022-4804
10.1016/j.jss.2019.09.048 [doi] S0022-4804(19)30693-6 [pii]
*Conservative Treatment/sn [Statistics & Numerical Data]
*Foreign Bodies/co [Complications]
*Rectum/in [Injuries]
*Surgical Procedures, Operative/sn [Statistics & Numerical Data]
*Wounds, Nonpenetrating/ep [Epidemiology]
Adolescent
Adult
Female
Foreign Bodies/th [Therapy]
Humans
Injury Severity Score
Length of Stay/sn [Statistics & Numerical Data]
Male
Middle Aged
Rectum/dg [Diagnostic Imaging]
Rectum/su [Surgery]
Retrospective Studies
Trauma Centers/sn [Statistics & Numerical Data]
Treatment Outcome
Wounds, Nonpenetrating/di [Diagnosis]
Wounds, Nonpenetrating/et [Etiology]
Wounds, Nonpenetrating/th [Therapy]
Young Adult
MedStar Washington Hospital Center
Surgery/Trauma Surgery
Journal Article