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Battle Injuries Of The Rectum: Options For The Field Surgeon
  1. C MacFarlane, HonsBA BSc(Hons) MBChB MMed(Surg) PhD FRCSEd FRCSEng FACS FCS(SA) FACEM(Hon) FFAEM MRACMA DMCC FRAeS1,
  2. CJ Vaizey, MD FRCS(Gen) FCS(SA), Consultant Colorectal Surgeon2 and
  3. CA Benn, MBBCh FCS(SA) DIP PEC(SA), Consultant Surgeon Chris Hani3
  1. 1Gauteng Provincial Government Emergency Medical Services, Hon. Lecturer, Johannesburg Hospital Trauma Unit and Dept. Surgery, University of the Witwatersrand, Johannesburg, PO Box 8311, Halfway House, 1685, South Africa.
  2. 2The Middlesex Hospital, Mortimer Street, London.
  3. 3Baragwanath Hospital and University of the Witwatersrand, Johannesburg, South Africa.

Abstract

Historically, battle wounds of the rectum have had high mortality and morbidity. This has improved greatly over several decades as a result of battle experience. This article highlights the value of civilian gunshot experience and its possible use in the military setting. The standard principles of rectal examination, followed by proctosigmoidoscopy after initial resuscitation, remain unchanged. Thereafter, the surgical decisions are made at laparotomy. Rectal injuries commonly have other injuries in association which must also be dealt with. In the stable patient rectal repair may be possible. Where repair is hazardous due to extensive injury (rectum or adjacent structures), the well-proven protective colostomy is used. A loop colostomy with or without distal closure is effective and is used to protect most injuries; possible exceptions being injuries dealt with early, in which there is minimal contamination and repair is easy. Presacral drainage can generally be reserved for severely destructive wounds or those in which repair has not been done. Rectal washout remains an option in patients with inspissated faeces. The basic military surgical principles remain valid, their extent and degree of implementation depending on the anatomical location of injury, degree of damage and any delay in presentation to surgery.

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