Contemporary management of rectal trauma - A South African experience

Penetrating buttock trauma is morbid but rarely fatal - A South African experience

BACKGROUND

Penetrating injuries to the buttock are relatively rare but are associated with significant morbidity. This study aimed to review our experience in managing penetrating trauma to the buttocks to contextualize the injury, document the most common associated injuries, and generate an algorithm to assist with the management of these patients.

METHODS

A retrospective study was conducted at a major trauma center in South Africa over 8 years (January 2012 to January 2020). All patients presenting with a penetrating buttock injury were included.

RESULTS

Our study included 40 patients. Gunshot wounds accounted for 93% (37/40), stab wounds accounted for 5% (2/40), and 1 case was gored by a cow. The majority (98%) underwent further investigation in the form of imaging or endoscopy. Forty percent (16/40) required surgical intervention. Of these 16 cases, 14 required a laparotomy, and 2 required gluteal exploration. Fifty-six percent (9/16) required a stoma. Five percent (2/40) experienced one or more complications, both of whom had stomas. The median length of stay for all patients was 3 days, whereas for the patients with stomas was 7 days. There were no ICU admissions or mortality in this study. Only 3 of the 9 stomas were reversed, and the median time to reversal was 16 months.

CONCLUSION

Penetrating trauma to the buttock may result in injuries to surrounding vital structures, which must be actively excluded. Rectal injury was the most common injury, and most required a defunctioning colostomy as part of the management resulting in significant morbidity.

Necrotizing Soft Tissue Infections of the Perineum

Necrotizing soft tissue infections of the perineum are rapidly progressing infections associated with significant morbidity and mortality. Prompt diagnosis and management with early surgical debridement is necessary to improve survival from this deadly disease. Repeat debridements are not uncommon. Important adjuncts to surgery include broad-spectrum antibiotics and management in an intensive care unit, as patients frequently develop multisystem organ failure. Once the acute phase is managed, fecal diversion with either an ostomy or fecal management catheter can be considered to decrease soiling of the wound and facilitate healing. Long-term management requires meticulous wound care, often with the assistance of negative pressure wound therapy. Patients may ultimately require skin grafts or tissue flaps for soft tissue coverage following extensive surgical debridements.

Extraperitoneal rectal trauma in a patient with multiple gunshot wounds: A case report and literature review

Penetrating rectal trauma is an uncommon presentation, particularly in centres with low rates of trauma, and requires a high index of suspicion to identify and treat. Management of penetrating rectal trauma has evolved over several decades and previously included proximal diversion, distal rectal washout, and presacral drainage as the primary surgical maneuvers to reduce mortality. Recently, a more conservative approach has been adopted, as the applicability of combat experience to the civilian setting has been questioned. In this report, a case of extraperitoneal rectal injury in a patient with multiple gunshot wounds provides a backdrop for literature review and discussion of the modern diagnostic and management approaches to penetrating rectal trauma.