Trauma of the Colon, Rectum, and Anus
The management of colonic trauma has evolved considerably over the past century and a half. The initial futility of abdominal surgery during the American Civil War gave way to mandatory colostomy in World War II. Recent well-done trials have now demonstrated the safety of primary repair in most patients, although care must still be used in damage control situations. Extraperitoneal rectal trauma is typically managed by proximal diversion; the utility of routine distal washout and presacral drainage has recently been called into question. Anal trauma lends itself to delayed reconstruction in many cases.