1. Rectal Injury After Foreign Body Insertion: Secondary Analysis From the AAST Contemporary Management of Rectal Injuries Study Group
- Author
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John P. Sharpe, Tashinga Musonza, Jack Sava, Vaidehi Agrawal, Martin A. Schreiber, Dennis Y. Kim, Richard Vasak, Morgan Schellenberg, Eric Bui, Ladonna Allen, Thomas M. Scalea, Julia R. Coleman, Brandon R. Bruns, Marc D. Trust, Brian J. Eastridge, Barbara U. Okafor, Eleanor Curtis, H. Andrew Hopper, Peter Bendix, Rachel E. Hicks, S. Rob Todd, Richard H. Lewis, Kenji Inaba, Clay Cothren Burlew, Cullen K. McCarthy, John B. Holcomb, Kelly L. Lightwine, Michael S. Truitt, Phillip M. Kemp Bohan, John Vanhorn, Zach M. Bauman, Matthew J. Martin, Gary Vercuysse, Carlos V.R. Brown, Raul Coimbra, Greg Victorino, Oscar D. Guillamondegui, Joseph M. Galante, James M. Haan, Alisa M. Cross, and Stephen C. Gale
- Subjects
Adult ,Male ,medicine.medical_specialty ,Adolescent ,medicine.medical_treatment ,Subgroup analysis ,Conservative Treatment ,Wounds, Nonpenetrating ,Young Adult ,03 medical and health sciences ,Injury Severity Score ,0302 clinical medicine ,Trauma Centers ,Laparotomy ,Secondary analysis ,Epidemiology ,medicine ,Rectal foreign body ,Humans ,Retrospective Studies ,medicine.diagnostic_test ,business.industry ,Rectum ,Length of Stay ,Middle Aged ,Foreign Bodies ,medicine.disease ,Proctoscopy ,Surgery ,Treatment Outcome ,Surgical Procedures, Operative ,030220 oncology & carcinogenesis ,Female ,030211 gastroenterology & hepatology ,Foreign body ,business ,Partial thickness - Abstract
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. 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. 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.
- Published
- 2020