American journal of surgery · 2026
Mechanism matters with traumatic rectal injuries: Multicenter analysis of blunt versus penetrating traumatic rectal injury management and associated outcomes.
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Bent Christine Isabella, Vojvodic Vanya, Nekooei Negar, Wong Monica D, Siletz Anaar E, Matsushima Kazuhide, Inaba Kenji, Brown Carlos, Martin Matthew J, AAST Contemporary Management of Rectal Injuries Study Group
Аннотация
OBJECTIVE: Examine the impact of injury mechanism and management strategies on outcomes after traumatic rectal injury (TRI).
BACKGROUND: TRI are uncommon, with most data derived from penetrating injuries. Whether management and outcomes differ between blunt (BR) and penetrating (PR) injuries remains unclear.
METHODS: A multicenter study across 22 trauma centers compared management patterns, use of the "4 Ds" adjuncts (drain, diversion, distal washout, direct repair), and outcomes between BR and PR.
RESULTS: Among 725 patients (511 PR, 214 BR), BR had higher injury severity, more abdominal complications, and required more interventions despite similar TRI grade. Mortality was lowest in PR managed with adjuncts and highest in BR without adjuncts. In BR, diversion-only management resulted in the highest complication and reintervention rates. Drain and distal washout were also associated with increased abdominal complications. Multivariable analysis showed diversion-only management independently increased complications versus primary repair.
CONCLUSION: BR carry greater morbidity than PR and may favor repair strategies.
BACKGROUND: TRI are uncommon, with most data derived from penetrating injuries. Whether management and outcomes differ between blunt (BR) and penetrating (PR) injuries remains unclear.
METHODS: A multicenter study across 22 trauma centers compared management patterns, use of the "4 Ds" adjuncts (drain, diversion, distal washout, direct repair), and outcomes between BR and PR.
RESULTS: Among 725 patients (511 PR, 214 BR), BR had higher injury severity, more abdominal complications, and required more interventions despite similar TRI grade. Mortality was lowest in PR managed with adjuncts and highest in BR without adjuncts. In BR, diversion-only management resulted in the highest complication and reintervention rates. Drain and distal washout were also associated with increased abdominal complications. Multivariable analysis showed diversion-only management independently increased complications versus primary repair.
CONCLUSION: BR carry greater morbidity than PR and may favor repair strategies.