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.”
Ct scan with IV contrast (not PO or rectal) is used to identify rectal injuries but will be diagnostic in only 33% of injuries.
Rectal Injury Grading Scale
Grade
Injury Type
Description of Injury
I
Hematoma laceration
Hematoma or hematoma without devascularization Partial-thickness laceration
II
Laceration
Laceration <50% of circumference
III
Laceration
Laceration ?50% of circumference
IV
Laceration
Full-thickness laceration with extension into perineum
V
Vascular
Devascularized segment
References
Contemporary diagnosis and management of colorectal injuries: What you need to know
