Rectal trauma occurs due to various injuries, like anorectal avulsion, automobile, gunshot or stab wounds, foreign body ingestion, drug trafficking, or erotic activity. Diagnosis may be difficult, especially in patients who cannot or will not offer a detailed description of their injury.
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 . In military injuries, type, trajectory, and velocity of the penetrating foreign body must be known in order to understand potential lesions .
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  . However, it can detect gross rectal blood loss and laceration  . 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.
Entire Body System
- 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]
- Recurrent Pulmonary Embolism
Two of the 20 patients (10 percent) died, one after a prolonged septic course and one from recurrent pulmonary embolism. Rectal trauma continues to be a challenging injury. [ncbi.nlm.nih.gov]
- 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]
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]
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]
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]
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]
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]
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]
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]
- Anal or Rectal Pain
[…] and Rectal Lesions Lesions or growths in and around the anus can cause rectal pain. [verywell.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]
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  in penetrating and blunt injuries  , 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 , 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 .
Computer tomography can be used in rectal trauma, but if associated bowel injury is suspected, evaluation can prove difficult  and oral, intravenous or rectal contrast should be used, if appropriate, in order to increase sensitivity and specificity . Bladder lesions can also be evaluated by this method. Triple-contrast helical computed tomography has higher accuracy if combined with contrast enema  . 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%) .
- 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]
In all these patients we believe the standard treatment would have included fecal diversion. Four patients sustained blunt trauma and five sustained penetrating trauma. [ncbi.nlm.nih.gov]
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]
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]
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]
[…] 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]
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]
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]
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.  Kadish et al. described differences in epidemiology and presentation of accidental and non-accidental [afrjpaedsurg.org]
[…] 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]
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]
He has since completed further training in emergency medicine, clinical toxicology, clinical epidemiology and health professional education. [lifeinthefastlane.com]
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]
The treatment included a primary repair of the rectum and a diverting colostomy so as to prevent sepsis. [chu-fes.ma]
Demographics, injury severity, and preventive antibiotics (24-hour) were similar between groups. [ncbi.nlm.nih.gov]
Can prevent progression of a rectal tear → higher grade → fecal contamination of abdomen → peritonitis Abdomen: peritonitis. Partial closure can prevent distraction of wound edges. [vetstream.com]
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