Advertisement

Techniques in Coloproctology

, Volume 22, Issue 11, pp 847–855 | Cite as

Rectal trauma injuries: outcomes from the U.S. National Trauma Data Bank

  • K. J. Gash
  • K. Suradkar
  • R. P. KiranEmail author
Original Article

Abstract

Background

There is a  lack of general consensus and a little published data regarding the management of trauma-related rectal injuries and outcomes. The aim of the present study was to evaluate the surgical management and corresponding outcomes for this patient cohort, using a nationwide trauma database.

Methods

Rectal injuries and procedures performed over a 2-year period (2013 and 2014) were identified through ICD-9 clinical modification codes, from the United States National Trauma Data Bank. Patient factors, management variables, and outcomes were evaluated.

Results

Of 1.7 million patients, 1472 (0.1%) sustained a rectal injury; 81% male, median age 30 years (range 16–89 years) and 60% due to penetrating trauma. Seven hundred and seventy-eight (52.8%) had an isolated extraperitoneal injury and 694 (47.2%) had isolated Intraperitoneal or combined intra- and extraperitoneal injuries. Overall, 726 patients (49.3%) underwent fecal diversion. Injuries following blunt trauma were associated with higher injury severity scores (ISS), lower stoma rates, longer hospital and intensive-care unit (ICU) stay, and higher mortality rates than penetrating trauma (all p ≤ 0.001). Patients with stoma formation had lower mortality than undiverted patients (8.6 vs. 4.0%, p < 0.001) despite a higher ISS and more intraperitoneal injuries, but longer hospital and ICU stay (all p ≤ 0.001). On multivariate regression analysis, older age, higher ISS, intraperitoneal injury, and return to the ICU were independently associated with higher rates of mortality, while stoma formation was associated with a lower mortality rate. For isolated extraperitoneal rectal injuries, 494 patients (63.5%) were managed by resection/repair without stoma and had significantly lower overall postoperative morbidity rates (12.7 vs. 30.2%, p = 0.009) and shorter hospital stay (14 vs. 23 days, p < 0.001), than those who underwent resection/repair + stoma (n = 284; 36.5%), despite no significant difference in ISS (29 vs. 27, p = 0.780). There was no significant difference in mortality.

Conclusions

Our results showed that trauma-related rectal injuries are rare and there is wide variation in their management. These data support a low threshold for stoma formation in patients with intraperitoneal or combined injuries, while suggesting that isolated extraperitoneal defects may be safely managed without fecal diversion.

Keywords

Rectal Colorectal Trauma Injury Surgery Outcomes 

Notes

Funding

Research Fellow (KG) funded by a US–UK Fulbright Scholarship/Royal College of Surgeons of England Research Scholarship.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

Institutional Review Board (IRB) approval was obtained from Columbia University Medical Center (IRB -AAAQ7032). The database consists of de-identified, HIPPA-compliant data.

Informed consent

For this type of study, formal consent is not required.

References

  1. 1.
    Hefny AF, Al-Ashaal YI, Bani-Hashem AM, Abu-Zidan FM (2010) Seatbelt syndrome associated with an isolated rectal injury: case report. World J Emerg Surg 5:4CrossRefGoogle Scholar
  2. 2.
    Carrillo EH, Somberg LB, Ceballos CE et al (1996) Blunt traumatic injuries to the colon and rectum. J Am Coll Surg 183:548–552PubMedGoogle Scholar
  3. 3.
    Maxwell RA, Fabian TC (2003) Current management of colon trauma. World J Surg 27:632–639CrossRefGoogle Scholar
  4. 4.
    Steele SR, Maykel JA, Johnson EK (2011) Traumatic injury of the colon and rectum: the evidence vs dogma. Dis Colon Rectum 54(9):1184–1201CrossRefGoogle Scholar
  5. 5.
    Hatch Q, Causey M, Martin M et al (2013) Outcomes after colon trauma in the 21st century: an analysis of the U.S. National Trauma Data Bank. Surgery 154(2):397–403CrossRefGoogle Scholar
  6. 6.
    Bosarge PL, Como JJ, Fox N et al (2016) Management of penetrating extraperitoneal rectal injuries: An eastern association for the surgery of trauma practice management guideline. J Trauma Acute Care Surg 80(3):546–551CrossRefGoogle Scholar
  7. 7.
    National Trauma Data Bank (NTDB), American College of Surgeons. http://www.facs.org/quality%20programs/trauma/ntdb. Accessed 20 Jan 2016
  8. 8.
    International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM). http://www.icd9data.com. Accessed March 2016
  9. 9.
    Baker SP, O’Neill B, Haddon W Jr, Long WB (1974) The Injury Severity Score: a method for describing patients with multiple injuries and evaluating emergency care. J Trauma 14(3):187–196CrossRefGoogle Scholar
  10. 10.
    Copes WS, Champion HR, Sacco WJ, Lawnick MM, Keast SL, Bain LW (1988) The injury severity score revisited. J Trauma 28(1):69–77CrossRefGoogle Scholar
  11. 11.
    Brohi K. Trauma.org website. http://www.trauma.org/index.php/main/article/383/. Accessed 13 Mar 2016
  12. 12.
    Wallace CMG (1917) A study of 1200 cases of gunshot wounds of the abdomen. Br J Surg 4:679–743CrossRefGoogle Scholar
  13. 13.
    McGrath V, Fabian TC, Croce MA, Minard G, Pritchard FE (1998) Rectal trauma: management based on anatomic distinctions. Am Surg 64(12):1136–1141PubMedGoogle Scholar
  14. 14.
    Taylor ER, Thompson JE (1948) The early treatment, and results thereof, of injuries of the colon and rectum, with 70 additional cases. J Am Med Assoc 138(1):209–228PubMedGoogle Scholar
  15. 15.
    Bosarge PL, Como JJ, Fox N, Falck-Ytter Y, Haut ER, Dorion HA, Patel NJ, Rushing A, Raff LA, McDonald AA, Robinson BR, McGwin G Jr, Gonzalez RP (2016) Management of penetrating extraperitoneal rectal injuries: an Eastern Association for the Surgery of Trauma practice management guideline. J Trauma Acute Care Surg 80(3):546–551CrossRefGoogle Scholar
  16. 16.
    Navsaria PH, Edu S, Nicol AJ (2007 Jun) Civilian extraperitoneal rectal gunshot wounds: surgical management made simpler. World J Surg 31(6):1345–1351CrossRefGoogle Scholar
  17. 17.
    Gonzalez RP, Phelan H 3rd, Hassan M, Ellis CN, Rodning CB (2006 Oct) Is fecal diversion necessary for nondestructive penetrating extraperitoneal rectal injuries? J Trauma 61(4):815–819. 18CrossRefGoogle Scholar
  18. 18.
    Levine JH, Longo WE, Pruitt C, Mazuski JE, Shapiro MJ, Durham RM (1996 Nov) Management of selected rectal injuries by primary repair. Am J Surg 172(5):575–578CrossRefGoogle Scholar
  19. 19.
    Weinberg JA, Fabian TC, Magnotti LJ, Minard G, Bee TK, Edwards N, Claridge JA, Croce MA (2006 Mar) Penetrating rectal trauma: management by anatomic distinction improves outcome. J Trauma 60(3):508–513CrossRefGoogle Scholar
  20. 20.
    Gonzalez RP, Turk B (2002) Surgical options in colorectal injuries. Scand J Surg 91:87–91CrossRefGoogle Scholar
  21. 21.
    Miller BJ, Schache DJ (1996) Colorectal injury: where do we stand with repair? ANZ J Surg 66:348–352CrossRefGoogle Scholar
  22. 22.
    Merlino JI, Reynolds HL (2004) Management of rectal injuries. Semin Colon Rectal Surg 15:70–79CrossRefGoogle Scholar
  23. 23.
    Cleary RK, Pomerantz RA, Lampman RM (2006) Colon and rectal injuries. Dis Colon Rectum 49(8):1203–1222CrossRefGoogle Scholar
  24. 24.
    Burch JM, Feliciano DV, Mattox KL (1989) Colstoma and drainage for civilian rectal injuries: is that all? Ann Surg 209(5):600–611CrossRefGoogle Scholar
  25. 25.
    Gonzalez RP, Falimirski ME, Holevar MR (1998) The role of presacral drainage in the management of penetrating rectal injuries. J Trauma 45(4):656–661CrossRefGoogle Scholar
  26. 26.
    Haider AH, Saleem T, Leow JJ et al (2012 May) Influence of the National Trauma Data Bank on the study of trauma outcomes: is it time to set research best practices to further enhance its impact? J Am Coll Surg 214(5):756–768CrossRefGoogle Scholar
  27. 27.
    National Center for Injury Prevention and Control. Web-based Injury Statistics Query and Reporting System (WISQARS) 2015 http://www.cdc.gov/injury/wisqars. Accessed 22 Mar 2016

Copyright information

© Springer Nature Switzerland AG 2018

Authors and Affiliations

  1. 1.Division of Colorectal SurgeryNew York Presbyterian Hospital/Columbia University Medical CenterNew YorkUSA
  2. 2.Mailman School of Public HealthColumbia UniversityNew YorkUSA

Personalised recommendations