Patients may present with isolated rectal trauma or associated injuries like pelvic fractures or penetrating abdominal, buttock or thigh injuries that are potentially life threatening. If severe, these lesions have a 50% mortality rate. Bone fragments may induce rectal wall laceration. While inquiring about the history of the disease, the physician must obtain information about any pain, tenesmus, incontinence and associated genitourinary and abdominal symptoms [1]. In military injuries, type, trajectory, and velocity of the penetrating foreign body must be known in order to understand potential lesions [2].

In selected cases, careful clinical examination (inspection, sphincter tonus assessment) followed by digital evaluation should be performed, although controversy exists regarding the utility of the latter method [3] [4]. However, it can detect gross rectal blood loss and laceration [5] [6]. In sexual assault, the physician should keep in mind that disruption of the rectal wall is likely and document evidence if the patient is stable. Prostate evaluation in men is useful if concomitant lesions of the urethra are suspected. Examination should also assess vital signs according to the Advanced Trauma Life Support protocol defined by the American College of Surgeons. Peritonitis and pelvic fracture signs should be looked for. If a perineal penetration wound is noticed, entry and exit signs should be documented. Women should also undergo vaginal bimanual and speculum examination with focus on the posterior wall.

• Pain

  Rectal analgesia for pain from perineal trauma following childbirth Rectal suppositories give short‐term pain relief for perineal trauma after childbirth. [cochranelibrary.com]

  Perineal, anal, or lower abdominal pain Signs of perforation or peritonitis: Guarding Rebound tenderness Fever Rectal bleeding Obstipation Presence of pelvic fracture History of an... [5minuteconsult.com]

  Symptoms can include pain and fever due to infection, painful bowel movement, swollen glands, and night sweats. [verywell.com]

  If you are in pain, get advice on pain relief medicines you can take. If any pain or bleeding from the anal area is associated with sex, stop sex and abstain until reviewed by a doctor. [healthdirect.gov.au]

  Abdominal pain, tenderness, ileus, and high temperature after a rectal trauma suggest perforation and peritonitis. [abdominalkey.com]

• Asymptomatic

  — A 51-year-old asymptomatic woman underwent DCBE examination for follow-up of a benign polyp removed from the sigmoid colon three years earlier. Toward the end of the examination, the retention balloon suddenly ruptured, expelling the catheter. [jamanetwork.com]

  While traumatic neuroma typically presents with pain, the aforementioned patient was asymptomatic from his lesion. [academic.oup.com]

  Two weeks later he visited the outpatient clinic and remained asymptomatic. He confirmed once more the aetiology of the incident. [afrjpaedsurg.org]

  […] advises a Cochrane review Immediate repair of perineal injury is better than delayed repair, to help reduce bleeding and pain No randomized studies suggest that primary overlap is better than primary end-to-end technique When to consider vaginal delivery Asymptomatic [mdedge.com]

  Most often related to auto-eroticism, a surprisingly wide list of reported foreign bodies may be introduced into the rectum, predominantly in men. [1] Clinical manifestations may range from asymptomatic cases, to rectal bleeding, and sometimes peritonitis [onlinejets.org]

• Perineal Pain

  Rectal analgesia for pain from perineal trauma following childbirth Rectal suppositories give short‐term pain relief for perineal trauma after childbirth. [cochranelibrary.com]

  Persistent pain and discomfort from perineal trauma may also cause urinary retention and defecation problems. [mdedge.com]

  2013/6/3/213/115350 A 38-year-old male presented to emergency department complaining of rectal bleeding accompanied by dull pelvic and perineal pain. [onlinejets.org]

• Severe Pain

  The formation of a perianal/perirectal abscess can cause fever and induce severe pain sometimes leading to general sepsis. Management and prognosis depend on the severity of the trauma. [abdominalkey.com]

  Inflammation and sores in the digestive tract can cause severe pain, malnutrition, intestinal scarring, bleeding, and weight loss. In some cases, removing the damaged area is the only effective treatment. [healthline.com]

  Exposed nerves and vessels result in moderate to severe pain. Pain worsens with bowel movements then decreases in between bowel movements. [emedicinehealth.com]

• Abdominal Pain

  pain Torn anal sphincter Foreign body that requires extraction in operating room Consider rectal injury in all patients presenting with abdominal pain following lower GI or genitourinary procedure. 60% of foreign bodies can be removed in ED. [5minuteconsult.com]

  Abdominal pain, tenderness, ileus, and high temperature after a rectal trauma suggest perforation and peritonitis. [abdominalkey.com]

  However, after douching himself, he began bleeding profusely from the rectum and developed severe central abdominal pain. He presented to the casualty department within 50 minutes by which time he had abdominal peritonism. [sti.bmj.com]

  You may have stomach pain or abdominal cramping with your bowel movements. You may have pain in your rectum or anal region when you are passing a bowel movement. You may have fever or chills with your abdominal pain or blood in your stools. [chemocare.com]

  Other symptoms include abdominal and /or rectal pain, dizziness, fainting, low blood pressure, vomiting, rapid heartbeat, and confusion. [emedicinehealth.com]

• Fecal Incontinence

  incontinence NOS, Gallstones, GERD, Germ cell tumor, Hemangioma, Hiatal hernia, Hirschsprung's disease, Hydrocele, Hyperhidrosis NOS, Idiopathic thrombocytopenic purpura, Inguinal hernia, Intestinal obstruction, Irritable bowel syndrome, Neuroblastoma [mayoclinic.org]

  Long-term efficacy of dynamic graciloplasty for fecal incontinence. Dis Colon Rectum 2002; 45 (6) 809-818 34 Thornton MJ, Kennedy ML, Lubowski DZ, King DW. Long-term follow-up of dynamic graciloplasty for faecal incontinence. [thieme-connect.com]

  The management of fecal incontinence is a struggle to maintain patient hygiene and limit the transmission of nosocomial infections. Intrarectal devices that cause diversion and collection of the fecal stream have been used with increasing frequency. [ncbi.nlm.nih.gov]

  She talks about incontinence and the symptoms of related problems. She goes on to discuss the various surgical and non-surgical treatments for fecal incontinence and other complications. Dr. [patientpower.info]

  FECAL INCONTINENCE Fecal incontinence is the inadvertent passage of flatus, liquid or solid stool. [aafp.org]

• Rectal Pain

  Both result in gastrointestinal inflammation and rectal pain. [verywell.com]

  Rectal pain is the symptom of pain in the area of the rectum. [en.wikipedia.org]

  An unexpected source of acute onset rectal pain One of my patients called our office, and insisted on making an appointment for her 14-year-old daughter for evaluation of a rectal tear. [clinicaladvisor.com]

  Hemorrhoids : Hemorrhoids are swollen rectal veins in the anal and rectal area. They can cause burning, painful discomfort, and bleeding. External hemorrhoids are small swellings that are easy to see and quite painful. Anal itching is common. [emedicinehealth.com]

  On presentation, the patient complained of peri-anal pruritis but denied rectal pain, hematochezia and dyschezia. [academic.oup.com]

• Tenesmus

  A common symptom of proctitis is called tenesmus. Tenesmus is a frequent urge to have a bowel movement. Inflammation and irritation of the rectum and rectal lining cause tenesmus. [healthline.com]

  While inquiring about the history of the disease, the physician must obtain information about any pain, tenesmus, incontinence and associated genitourinary and abdominal symptoms. [symptoma.com]

  Despite tenesmus and the urge to stimulate herself digitally, she was unable to produce stool. The patient reported no recent vomiting, diarrhea, weight loss, or history of rectal instrumentation or trauma. [mdmag.com]

  Epidural anesthesia Anesthesia: epidural may be necessary to reduce peristalsis and tenesmus. This can be achieved using lidocaine Lidocaine, but xylazine Xylazine may be preferred as it causes less ataxia and weakness. [vetstream.com]

• Blood in Stool

  The injury may be nothing more than a blood clot within the wall of the colon, but this can perforate and rupture later in time. Blood in stool after car accidents is one of the colon trauma symptoms. [autoaccident.com]

  When to see a doctor See your health care provider if you have pain during bowel movements or notice blood on stools or toilet paper after a bowel movement. [mayoclinic.org]

• Hypotension

  Airway, breathing, and circulation Spinal precautions if blunt trauma Fluid resuscitation if blood loss, hypotension Do not attempt removal of rectal foreign body Control bleeding Initial Stabilization/Therapy Perforation Significant bleeding Unstable [5minuteconsult.com]

  Univariate analysis identified Abdominal Trauma Index ≥25 or hypotension in the emergency room to be associated with increased risk of anastomotic leak. [thoracickey.com]

  Following Advanced Trauma Life Support (ATLS) protocol; primary survey revealed elevated heart rate, hypotension and signs of generalized peritonitis as well as malodorous discharge form the perineal area, Trauma team took him to the Operating Room (OR [jcol.elsevier.es]

  It is generally accepted that intraperitoneal injuries do not benefit from ostomy formation with the exception of settings where the patient is persistently hypotensive or requiring high volume of transfusions.1 16 Intraperitoneal injuries are treated [tsaco.bmj.com]

  INDICATIONS FOR DRE IN TRAUMA PATIENTS Perform a DRE in a trauma patient if: pelvic fractures (complications and associated injuries may be detected) abnormal neurological findings hypotension penetrating abdominal or perineal trauma with possible rectal [lifeinthefastlane.com]

• Pruritus

  It should be noted that uncomplicated hemorrhoids rarely cause pruritus ani. Only hemorrhoidal tags that are inflamed or associated with poor hygiene may produce pruritus. [aafp.org]

• Confusion

  We believe significant confusion arises because of imprecise definition of injury location relative to retroperitoneal involvement. Our 5-year experience with penetrating rectal injuries at a Level I trauma center was analyzed. [ncbi.nlm.nih.gov]

  Case presentation A 58-year-old male was admitted with confusion and inability to speak. His past history was notable for hospitalization to extract a retained plastic soda bottle from the rectosigmoid two years prior. [bmcinfectdis.biomedcentral.com]

  Other symptoms include abdominal and /or rectal pain, dizziness, fainting, low blood pressure, vomiting, rapid heartbeat, and confusion. [emedicinehealth.com]

  Abstract Favorites PDF Get Content & Permissions Open Translation and validation of the Tibetan confusion assessment method for the intensive care unit Danzeng, Qu-Zhen; Cui, Na; Wang, Hao; More Chinese Medical Journal. 132(10):1154-1158, May 20, 2019 [cmj.org]

  Pale, diaphoretic, confused. No head injury. Ecchymoses around chest and abdomen. Distended abdomen. Pelvis grossly unstable. Gross hematuria. Scroll through the images on the left and describe the findings. [radiologyassistant.nl]

• Renal Injury

  On the left a typical subcapsular hematoma, which is also a grade I renal injury. Some final remarks on renal injury: CT has facilitated shift toward NOM. 98% of renal injuries now NOM. [radiologyassistant.nl]

Clinical evaluation should be followed by blood workup and imaging studies. The complete blood cell count may show acute posthemorrhagic anemia. Rigid or flexible proctoscopy or sigmoidoscopy offer valuable information [7] in penetrating and blunt injuries [8] [9], but they should be performed carefully and gently by an experienced doctor in order to prevent further injury. Despite the fact that they are the gold standard in detecting rectal damage [5], if other imaging methods offer reliable information, they can be excluded from the workup. However, sigmoidoscopy can sometimes fail to identify wounds and may have up to 31% false negative results [10].

Computer tomography can be used in rectal trauma, but if associated bowel injury is suspected, evaluation can prove difficult [11] and oral, intravenous or rectal contrast should be used, if appropriate, in order to increase sensitivity and specificity [12]. Bladder lesions can also be evaluated by this method. Triple-contrast helical computed tomography has higher accuracy if combined with contrast enema [13] [14]. This latter method can also be applied by itself.

Guaiac testing is another complementary diagnosis method. It has acceptable sensitivity (69%), but low specificity (33%) [15].

• Rectal Ulcer

  […] prolapse, Rhabdomyosarcoma, Sarcoma, Solitary rectal ulcer syndrome, Ulcerative colitis, Umbilical hernia, Wilms' tumor more see full list in profile [mayoclinic.org]

  Although effective, the Flexi-Seal fecal management system should be used with caution to avoid rectal trauma. Injury is most likely to occur because of traumatic removal or rectal ulceration secondary to pressure necrosis. [ncbi.nlm.nih.gov]

  Karger AG, Basel Introduction Solitary rectal ulcer syndrome (SRUS) is a chronic, benign disorder of defecation. [karger.com]

Rationale for inclusion: This retrospective review advocated for the treatment of low velocity penetrating extraperitoneal rectal injuries with fecal diversion alone, without need for repair or presacral drainage. [east.org]

Diagnosis and management of rectal blunt trauma is still a matter of debate and no definitive recommendation treatments are available. [ncbi.nlm.nih.gov]

Equis ISSN 2398-2977 Synonym(s): Rectal liner Contributor(s): Prof Gary M Baxter, Timothy Mair, Graham Munroe Introduction Initial management First aid and prompt referral/treatment is of paramount importance to prognosis. [vetstream.com]

[…] mesenteric vessels 4, 7 abrupt termination of the mesenteric vessels 7 accumulation ('pooling') of contrast on multiphase imaging suggestive signs 7 mesenteric infilatration: haziness and fat stranding mesenteric hematoma bowel wall thickening Treatment and prognosis [radiopaedia.org]

Management and prognosis depend on the severity of the trauma. The American Association for the Surgery of Trauma attempted to quantify the severity of anal trauma and proposed the Rectal Injury Scaling System comprising five degrees of severity. [abdominalkey.com]

Prognosis Failure rates as high as 35% have been reported following treatment of rectal gonorrhea; symptoms frequently recur. [emedicine.medscape.com]

What Is the Prognosis for Rectal Bleeding? The majority of people with significant rectal bleeding are elderly. Members of this population commonly have many other medical problems. [emedicinehealth.com]

Article / Publication Details First-Page Preview Abstract Colitis cystica profunda (CCP) is a rare benign condition with a controversial etiology. [karger.com]

Etiology• Blunt trauma• This is rare due to the protected situation of the anus and rectum and it is usually associated with fracture pelvis. The commonest cause is motor vehicle accidents followed by falls and crush injuries. 4. [slideshare.net]

Toxins (eg, hydrogen peroxide enemas) Vasculitis Cytomegalovirus (CMV) Clostridium difficile Campylobacter species Epidemiology United States data Frequencies of proctitis are associated with their individual etiologies. [emedicine.medscape.com]

This chapter describes the most frequent etiologies of anal/rectal trauma and the basic clinical and instrumental investigations necessary to provide the most appropriate treatment, particularly in emergencies, when saving patient’s life is a surgeon’ [link.springer.com]

[…] therapy Immunodeficiency disorders Crohn disease Syphilis (usually secondary) Papillomavirus Amebiasis Lymphogranuloma venereum Ischemia Toxins (eg, hydrogen peroxide enemas) Vasculitis Cytomegalovirus (CMV) Clostridium difficile Campylobacter species Epidemiology [emedicine.medscape.com]

It remains to be emphasized that in case of delayed presentation and an inconsistent history regarding the trauma mechanism, sexual abuse has to be excluded. [5] Kadish et al. described differences in epidemiology and presentation of accidental and non-accidental [afrjpaedsurg.org]

Epidemiology of modern battlefield colorectal trauma: a review of 977 coalition casualties. J Trauma Acute Care Surg. 2012;73(06, Suppl 5): S503-S508. doi: 10.1097/TA.0b013e3182754759. [ Links ] 5. [scielo.org.co]

He has since completed further training in emergency medicine, clinical toxicology, clinical epidemiology and health professional education. [lifeinthefastlane.com]

Epidemiology of modern battlefield colorectal trauma: a review of 977 coalition casualties. J Trauma Acute Care Surg 2012; 73 (06) (Suppl. 05) S503-S508 4 Cho SD, Kiraly LN, Flaherty SF, Herzig DO, Lu KC, Schreiber MA. [thieme-connect.de]

Pathophysiology Proctitis involves mucosal cell loss, acute inflammation of the lamina propria, eosinophilic crypt abscess, and endothelial edema of the arterioles. [emedicine.medscape.com]

Zhu QC, Shen RR, Quin HL, Wang Y: Solitary rectal ulcer syndrome: clinical features, pathophysiology, diagnosis and treatment strategies. World J Gastroenterol 2014; 20: 738–744. Author Contacts M. Gruber St. [karger.com]

Google Scholar | Medline | ISI Horrocks, CL. ( 2001 ) Blast injuries: biophysics, pathophysiology and management principles. Journal of the Royal Army Medical Corps 147(1): 28 – 40. [journals.sagepub.com]

It is important to rule out fecal impaction with overflow before seeking a pathophysiologic cause for uncontrolled passage of liquid stool. [aafp.org]

“Prevention efforts are needed to communicate sexual or sex-associated routes of transmission for hepatitis C that cannot be prevented by condoms alone”, conclude the investigators. Reference Schmidt AJ et al. [aidsmap.com]

Demographics, injury severity, and preventive antibiotics (24-hour) were similar between groups. [ncbi.nlm.nih.gov]

The treatment included a primary repair of the rectum and a diverting colostomy so as to prevent sepsis. [wjes.biomedcentral.com]

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