Rectal Injury After Foreign Body Insertion: Secondary Analysis From the AAST Contemporary Management of Rectal Injuries Study Group.

Adolescent Adult Conservative Treatment / statistics & numerical data Female Foreign Bodies / complications Humans Injury Severity Score Length of Stay / statistics & numerical data Male Middle Aged Rectum / diagnostic imaging Retrospective Studies Surgical Procedures, Operative / statistics & numerical data Trauma Centers / statistics & numerical data Treatment Outcome Wounds, Nonpenetrating / diagnosis Young Adult

Computed tomography Proctoscopy Rectal injury Rectal trauma Retained foreign body

Journal

The Journal of surgical research

ISSN: 1095-8673

Titre abrégé: J Surg Res

Pays: United States

ID NLM: 0376340

Informations de publication

Date de publication:
03 2020

Historique:

received: 27 06 2019

revised: 04 09 2019

accepted: 20 09 2019

pubmed: 28 10 2019

medline: 11 6 2020

entrez: 26 10 2019

Statut: ppublish

Résumé

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. 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). 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. 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.

Sections du résumé

BACKGROUND

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.

Identifiants

DOI: 10.1016/j.jss.2019.09.048 PMID: 31648812

pubmed: 31648812

pii: S0022-4804(19)30693-6

doi: 10.1016/j.jss.2019.09.048

pii:

doi:

Types de publication

Comparative Study Journal Article Multicenter Study

Langues

eng

Sous-ensembles de citation

Pagination

541-546

Investigateurs

Richard H Lewis (RH)

S Rob Todd (SR)

Rachel E Hicks (RE)

Greg Victorino (G)

Thomas M Scalea (TM)

Oscar Guillamondegui (O)

Vaidehi Agrawal (V)

Julia R Coleman (JR)

Matthew J Martin (MJ)

Cullen K McCarthy (CK)

Dennis Kim (D)

Zach M Bauman (ZM)

Joseph Galante (J)

Kelly Lightwine (K)

Martin Schreiber (M)

Ladonna Allen (L)

Barbara U Okafor (BU)