A differentiated algorithm for providing surgical care for rectal injuries at the stages of medical evacuation

AIM: to develop an algorithm for rectal injuries (RI) at the stages of medical evacuation (MEE), based on differentiated approach to surgery and indications for drainage of the pelvic spaces (PCS).

PATIENTS AND METHODS: in March 2023 — December 2024, 135 patients (aged 34.3 ± 4.2; 99.2% males) were included in retrospective study. The 1st group (n = 93) included patients with intra-abdominal RI. The 2nd group (n = 42) included patients with extraperitoneal RPK. The characteristics of the wounds, the combination of injuries with other organs and systems, type and volume of surgery were evaluated. In group with extraperitoneal injuries 18 patients underwent surgery with active drainage of the presacral space and 24 — standard bilateral perineal pelvic drainage. Pain, clinical and biochemical indicators were evaluated on the 1st and 3rd days.

RESULTS: RI suturing was performed in 28.5–30.2% of case, rectal resection — in 57.9%, more often in intraabdominal injuries — (69.8% vs 11.9% for extraabdominal; p < 0.05). Hartmann’s procedure was done in 21.5% of cases, and a loop colostomy — in 29% of cases. In 35.7% of clinical cases, a rectal resection was done due to injuries missed at previous stages. Necrotic changes in the pelvis developed on the 2nd day in 12.5% of cases, and on the 3rd day or more in 62.5% of cases with standard bilateral pararectal drainage. In the group with active drainage of the presacral space no major complications occurred.

CONCLUSION: the developed algorithm for rectal injuries is effective, active pelvic drainage is superior to standard one.

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