Rectal Injuries

There are both blunt and penetrating mechanisms by which rectal injuries can occur. The patient’s physical exam findings (abdominal tenderness, seat belt sign, ecchymosis, or blood at the perineum) can be suggestive of injury to the rectum. Blunt injuries to the rectum are uncommon due to protection from bony pelvis but can be seen with severe pelvic fractures. Penetrating injuries can result from trans-pelvic gunshot wounds, perineal impalement, iatrogenic processes, foreign body insertion, or sex-related injuries. If concern for a rectal injury exists, the next step is to confirm the presence of the injury and then determine if it is intraperitoneal versus extraperitoneal. If the patient is stable and appropriate to undergo further workup, a computerized tomography (CT) scan should be performed (with intravenous and water-soluble rectal contrast, if appropriate). The CT scan can show bowel injury, extraluminal air, contrast extravasation, or intestinal discontinuity. Extraperitoneal injuries can be managed operatively or non-operatively with or without fecal diversion with colostomy, depending on the severity of the injury and the overall injury burden of the patient.