Title: Rectal Injuries-part one<br/>
Author: Robert Flint<br/>
<a href='mailto:rflint@som.umaryland.edu'>[Click to email author]</a><hr/>
Link: <a href='https://umem.org/educational_pearls/4627/'>https://umem.org/educational_pearls/4627/</a><hr/><p>Rectal injuries are rare. The majority are secondary to penetrating injuries. Trauma care providers “should have a high clinical suspicion of rectal injury with any missile with a trajectory near the rectum; transpelvic gunshot wounds; stab injuries near the perineum, buttocks, groin, or proximal thighs; or open pelvic fractures. A digital rectal examination with a focus on sphincter tone, presence of blood, palpable defect, or bony protrusion should be carried out. Of note, a normal digital rectal examination does not exclude rectal injury.”</p>
<p>Ct scan with IV contrast (not PO or rectal) is used to identify rectal injuries but will be diagnostic in only  33% of injuries. </p>
<p>Rectal Injury Grading Scale</p>
<table>
<thead>
<tr>
<th><strong>Grade</strong></th>
<th><strong>Injury Type</strong></th>
<th><strong>Description of Injury</strong></th>
</tr>
</thead>
<tbody>
<tr>
<td>I</td>
<td>Hematoma laceration</td>
<td>Hematoma  or hematoma without devascularization Partial-thickness laceration</td>
</tr>
<tr>
<td>II</td>
<td>Laceration</td>
<td>Laceration <50% of circumference</td>
</tr>
<tr>
<td>III</td>
<td>Laceration</td>
<td>Laceration ?50% of circumference</td>
</tr>
<tr>
<td>IV</td>
<td>Laceration</td>
<td>Full-thickness laceration with extension into perineum</td>
</tr>
<tr>
<td>V</td>
<td>Vascular</td>
<td>Devascularized segment</td>
</tr>
</tbody>
</table>
<fieldset><legend>References</legend><h2>Contemporary diagnosis and management of colorectal injuries: What you need to know</h2>
<p>Fields, Adam MD, MPH; Salim, Ali MD, FACS</p>
<p><em>Journal of Trauma and Acute Care Surgery</em> <a href="https://journals.lww.com/jtrauma/pages/currenttoc.aspx">97(4):p 497-504, October 2024.</a> | <em>DOI:</em> 10.1097/TA.0000000000004352</p>
</fieldset>