Rectal Injury After Foreign Body Insertion: Secondary Analysis From the AAST Contemporary Management of Rectal Injuries Study Group

Morgan Schellenberg; Carlos V R Brown; Marc D Trust; John P Sharpe; Tashinga Musonza; John Holcomb; Eric Bui; Brandon Bruns; H Andrew Hopper; Michael S Truitt; Clay C Burlew; Kenji Inaba; Jack Sava; John Vanhorn; Brian Eastridge; Alisa M Cross; Richard Vasak; Gary Vercuysse; Eleanor E Curtis; James Haan; Raul Coimbra; Phillip Bohan; Stephen Gale; Peter G Bendix; AAST Contemporary Management of Rectal Injuries Study Group

doi:10.1016/j.jss.2019.09.048

Rectal Injury After Foreign Body Insertion: Secondary Analysis From the AAST Contemporary Management of Rectal Injuries Study Group

J Surg Res. 2020 Mar:247:541-546. doi: 10.1016/j.jss.2019.09.048. Epub 2019 Oct 21.

Authors

Morgan Schellenberg¹, Carlos V R Brown², Marc D Trust³, John P Sharpe⁴, Tashinga Musonza⁴, John Holcomb⁵, Eric Bui⁶, Brandon Bruns⁷, H Andrew Hopper⁸, Michael S Truitt⁹, Clay C Burlew¹⁰, Kenji Inaba³, Jack Sava¹¹, John Vanhorn¹², Brian Eastridge¹³, Alisa M Cross¹⁴, Richard Vasak¹⁵, Gary Vercuysse¹⁶, Eleanor E Curtis¹⁷, James Haan¹⁸, Raul Coimbra¹⁹, Phillip Bohan²⁰, Stephen Gale²¹, Peter G Bendix²²; AAST Contemporary Management of Rectal Injuries Study Group

Collaborators

AAST Contemporary Management of Rectal Injuries Study Group:
Richard H Lewis, S Rob Todd, Rachel E Hicks, Greg Victorino, Thomas M Scalea, Oscar Guillamondegui, Vaidehi Agrawal, Julia R Coleman, Matthew J Martin, Cullen K McCarthy, Dennis Kim, Zach M Bauman, Joseph Galante, Kelly Lightwine, Martin Schreiber, Ladonna Allen, Barbara U Okafor

Affiliations

¹ LAC+USC Medical Center, University of Southern California, Los Angeles, California. Electronic address: [email protected].
² Dell Medical School, University of Texas at Austin, Austin, Texas.
³ LAC+USC Medical Center, University of Southern California, Los Angeles, California.
⁴ University of Tennessee Health Science Center, Memphis, Tennessee.
⁵ University of Texas Health Science Center at Houston, Houston, Texas.
⁶ University of San Francisco-East Bay, Oakland, California.
⁷ R Adams Cowley Shock Trauma Center, University of Maryland, Baltimore, Maryland.
⁸ Vanderbilt University, Nashville, Tennessee.
⁹ Methodist Health System, Dallas, Texas.
¹⁰ Denver Health Medical Center, University of Colorado, Denver, Colorado.
¹¹ MedStar Washington Hospital Center, Washington, District of Columbia.
¹² Legacy Emanuel Medical Center, Portland, Oregon.
¹³ University of Texas Health Science Center San Antonio, San Antonio, Texas.
¹⁴ University of Oklahoma, Oklahoma City, Oklahoma.
¹⁵ Harbor-UCLA Medical Center, Los Angeles, California.
¹⁶ University of Arizona, Tucson, Arizona.
¹⁷ University of California Davis, Sacramento, California.
¹⁸ Via Christi Health, Wichita, Kansas.
¹⁹ University of California San Diego, San Diego, California.
²⁰ Oregon Health and Science University, Portland, Oregon.
²¹ East Texas Medical Center, Tyler, Texas.
²² Brigham and Women's Hospital, Boston, Massachusetts.

PMID: 31648812
DOI: 10.1016/j.jss.2019.09.048

Abstract

Background: Retained rectal foreign bodies are a common but incompletely studied problem. This study defined the epidemiology, injury severity, and outcomes after rectal injuries following foreign body insertion.

Methods: Twenty-two level I trauma centers retrospectively identified all patients sustaining a rectal injury in this AAST multi-institutional trial (2005-2014). Only patients injured by foreign body insertion were included in this secondary analysis. Exclusion criteria were death before rectal injury management or ≤48 h of admission. Demographics, clinical data, and outcomes were collected. Study groups were defined as partial thickness (AAST grade I) versus full thickness (AAST grades II-V) injuries. Subgroup analysis was performed by management strategy (nonoperative versus operative).

Results: After exclusions, 33 patients were identified. Mean age was 41 y (range 18-57), and 85% (n = 28) were male. Eleven (33%) had full thickness injuries and 22 (67%) had partial thickness injuries, of which 14 (64%) were managed nonoperatively and 8 (36%) operatively (proximal diversion alone [n = 3, 14%]; direct repair with proximal diversion [n = 2, 9%]; laparotomy without rectal intervention [n = 2, 9%]; and direct repair alone [n = 1, 5%]). Subgroup analysis of outcomes after partial thickness injury demonstrated significantly shorter hospital length of stay (2 ± 1; 2 [1-5] versus 5 ± 2; 4 [2-8] d, P = 0.0001) after nonoperative versus operative management.

Conclusions: Although partial thickness rectal injuries do not require intervention, difficulty excluding full thickness injuries led some surgeons in this series to manage partial thickness injuries operatively. This was associated with significantly longer hospital length of stay. Therefore, we recommend nonoperative management after a retained rectal foreign body unless full thickness injury is conclusively identified.

Keywords: Computed tomography; Proctoscopy; Rectal injury; Rectal trauma; Retained foreign body.

Publication types

Comparative Study
Multicenter Study

MeSH terms

Adolescent
Adult
Conservative Treatment / statistics & numerical data*
Female
Foreign Bodies / complications*
Foreign Bodies / therapy
Humans
Injury Severity Score
Length of Stay / statistics & numerical data
Male
Middle Aged
Rectum / diagnostic imaging
Rectum / injuries*
Rectum / surgery
Retrospective Studies
Surgical Procedures, Operative / statistics & numerical data*
Trauma Centers / statistics & numerical data
Treatment Outcome
Wounds, Nonpenetrating / diagnosis
Wounds, Nonpenetrating / epidemiology*
Wounds, Nonpenetrating / etiology
Wounds, Nonpenetrating / therapy
Young Adult