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Like colonic injuries, fecal diversion for penetrating rectal injuries was

popularized during World War II. Mortality from rectal injuries decreased from 90

percent efore World War I wit! nonoperative management, to "# percent during

World War I w!en primary suture was used, to $0 percent during World War II

w!en t!e %urgeon &eneral mandated fecal diversion and presacral drainage, to

'( percent during t!e )ietnam con*ict w!en primary repair was performed w!enpossile along wit! distal rectal was!out.'$+,'#-'#( etter resuscitation

tec!ni/ues and antiiotics also were credited wit! contriuting to t!is decrease

in mortality.'#,'#( 1!e management of penetrating rectal injuries largely

depends on t!e level and e2tent of t!e injury. 3 !ig! inde2 of suspicion s!ould e

present w!en evaluating t!ose w!o su4er penetrating injuries of t!e lower

adomen, pelvis, and perineum. 3fter completion of t!e 31L% primary survey,

secondary survey s!ould include t!oroug! e2amination of t!e adomen,

genitals, perineum, and pelvis ecause rectal injuries are associated wit! injuries

to t!ese regions, especially pelvic fractures.'#",'## 5iagnostic evaluations

include digital rectal e2amination, cystouret!rograms, proctosigmoidoscopy,

adominal and pelvic 26rays, water6solule contrast studies, peritoneal lavage,and 71 scanning. 5igital e2amination may demonstrate lood on t!e e2amining

8nger. roctosigmoidoscopy may reveal a rectal injury or may demonstrate lood

in t!e lumen wit!out identifying t!e e2act site of injury. :ccult injuries may e

missed and t!is study s!ould not e relied on to e2clude rectal injury, especially

in unprepped owel.'#+-'+0 Water6solule contrast studies may s!ow contrast

e2travasation. 3 cystouret!rogram or 71 scan may demonstrate uret!ral or

ladder e2travasation, and t!e latter also may reveal a retroperitoneal

!ematoma.'#",'#+,'+' 1reatment options for penetrating injuries to t!e rectum

include transanal repair of low injuries and celiotomy wit! repair of upper rectal

injuries, wit! or wit!out fecal diversion, distal rectal was!out, and presacral

drainage. Most surgeons agree t!at intraadominal moilization of t!e

e2traperitoneal rectum, deep in t!e pelvis, in searc! of a mid or low rectal injury

t!at may e di;cult to visualize and repair is proaly not warranted.,'#"

%evere devitalizing injuries of t!e rectum may re/uire an e2tended low anterior

resection. 3t one time or anot!er, fecal diversion, distal rectal was!out, and

presacral drainage !ave all een recommended in t!e treatment of penetrating

rectal injuries, alone or in comination. %ince World War II,

%eperti cedera kolon, pengali!an tinja untuk menemus

cedera duur dipopulerkan selama erang 5unia

II.

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%eua! indeks kecurigaan yang tinggi !arus !adir ketika

mengevaluasi mereka yang menderita luka temus dari

perut agian awa!, panggul, dan perineum. %etela!

penyelesaian survei primer 31L%, sekunder

%urvei !arus mencakup pemeriksaan menyeluru! dari

perut, alat kelamin, perineum, dan panggul karenacedera duur er!uungan dengan cedera ini

daera!, fractures.'#",'## terutama panggul 5iagnostik

evaluasi mencakup pemeriksaan colok duur, cystouret!rograms,

proctosigmoidoscopy, perut

dan 26ray panggul, studi kontras yang larut dalam air,

lavage peritoneal, dan 71 scan. pemeriksaan digital

mungkin menunjukkan dara! di jari memeriksa.

roctosigmoidoscopy dapat mengungkapkan cedera duur atau

mungkin menunjukkan dara! dalam lumen tanpa

mengidenti8kasi situs yang tepat cedera. cedera okultisme

mungkin terlewatkan dan studi ini tidak !arus mengandalkanuntuk mengecualikan cedera duur, terutama di unprepped

%tudi kontras owel.'#+6'+0 larut dalam air dapat

menunjukkan kontras ekstravasasi. %eua! voiding atau

71 scan dapat menunjukkan uretra atau kandung kemi! ekstravasasi,

dan yang terak!ir juga dapat mengungkapkan retroperitoneal a

!ematoma.'#",'#+,'+'

ili!an pengoatan untuk luka temus ke

rektum meliputi peraikan transanal cedera renda! dan

celiotomy dengan peraikan cedera duur atas, dengan atau

tanpa pengali!an tinja, was!out duur distal, dan

drainase presacral.