CONTEMPORARY DIAGNOSIS AND MANAGEMENT OF COLORECTAL INJURIES: WHAT YOU NEED TO KNOW.

Abstract

Colorectal injuries are commonly encountered by trauma surgeons. The management of colorectal injuries has evolved significantly over the past several decades, beginning with wartime experience and subsequently refining with prospective randomized studies. Colon injuries were initially nonoperative, evolved towards fecal diversion for all, then became anatomic based with resection and primary anastomosis with selective diversion, and now primary repair, resection with primary anastomosis, or delayed anastomosis after damage control laparotomy are all commonplace. Rectal injuries were also initially considered non-operative until diversion came into favor. Diversion in addition to direct repair, presacral drain placement, and distal rectal washout became the gold standard for extraperitoneal rectal injuries until drainage and washout fell out of favor. Despite a large body of evidence, there remains debate on the optimal management of some colorectal injuries. This article will focus on how to diagnose and manage colorectal injuries. The aim of this review is to provide an evidence-based summary of the contemporary diagnosis and management of colorectal injuries.