Anorectal Traumatic Injuries

Abstract

Injuries of the colon and rectum are common surgical problems. They result from penetrating and blunt abdominal trauma, pelvic fractures, anal erotism, barium enema, and colorectal endoscopy. Mortality from anorectal trauma has decreased during the past century. Knowledge acquired during wartime and applied in civilian practice has contributed to this outcome improvement. Before World War I the mortality was 90% with nonoperative management, decreasing to 67% during this war when the primary suture technique was introduced. During World War II the mortality decreased to 30% with the use of fecal diversion and presacral drainage. During the Vietnam conflict, primary repair was performed when possible along with distal rectal washout, with a mortality of 15% [1–3]. Improvement in resuscitation, quick evacuation of the wounded soldier, and widespread use of antibiotics resulted in a further decrease in mortality to less than 6% [3, 4]. Multisystem injuries are common, and these patients are best served by a multidisciplinary team that includes visceral surgeons, urologists, orthopedic surgeons, and plastic surgeons [4].