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

The AAST Contemporary Management of Rectal Injuries Study Group

Research output: Contribution to journalArticle

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.

Original languageEnglish (US)
JournalJournal of Surgical Research
DOIs
StateAccepted/In press - Jan 1 2019

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Foreign Bodies
Wounds and Injuries
Length of Stay
Trauma Centers
Laparotomy
Epidemiology
Demography

Keywords

  • Computed tomography
  • Proctoscopy
  • Rectal injury
  • Rectal trauma
  • Retained foreign body

ASJC Scopus subject areas

  • Surgery

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

In: Journal of Surgical Research, 01.01.2019.

Research output: Contribution to journalArticle

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title = "Rectal Injury After Foreign Body Insertion: Secondary Analysis From the AAST Contemporary Management of Rectal Injuries Study Group",
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",
author = "{The AAST Contemporary Management of Rectal Injuries Study Group} and Morgan Schellenberg and Brown, {Carlos V.R.} and Trust, {Marc D.} and Sharpe, {John P.} and Tashinga Musonza and John Holcomb and Eric Bui and Brandon Bruns and Hopper, {H. Andrew} and Truitt, {Michael S.} and Burlew, {Clay C.} and Kenji Inaba and Jack Sava and John Vanhorn and Brian Eastridge and Cross, {Alisa M.} and Richard Vasak and Gary Vercuysse and Curtis, {Eleanor E.} and James Haan and Raul Coimbra and Phillip Bohan and Stephen Gale and Bendix, {Peter G.} and Lewis, {Richard H.} and Todd, {S. Rob} and Hicks, {Rachel E.} and Greg Victorino and Scalea, {Thomas M.} and Oscar Guillamondegui and Vaidehi Agrawal and Coleman, {Julia R.} and Martin, {Matthew J.} and McCarthy, {Cullen K.} and Dennis Kim and Bauman, {Zach M.} and Joseph Galante and Kelly Lightwine and Martin Schreiber and Ladonna Allen and Okafor, {Barbara U.}",
year = "2019",
month = "1",
day = "1",
doi = "10.1016/j.jss.2019.09.048",
language = "English (US)",
journal = "Journal of Surgical Research",
issn = "0022-4804",
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T1 - Rectal Injury After Foreign Body Insertion

T2 - Secondary Analysis From the AAST Contemporary Management of Rectal Injuries Study Group

AU - The AAST Contemporary Management of Rectal Injuries Study Group

AU - Schellenberg, Morgan

AU - Brown, Carlos V.R.

AU - Trust, Marc D.

AU - Sharpe, John P.

AU - Musonza, Tashinga

AU - Holcomb, John

AU - Bui, Eric

AU - Bruns, Brandon

AU - Hopper, H. Andrew

AU - Truitt, Michael S.

AU - Burlew, Clay C.

AU - Inaba, Kenji

AU - Sava, Jack

AU - Vanhorn, John

AU - Eastridge, Brian

AU - Cross, Alisa M.

AU - Vasak, Richard

AU - Vercuysse, Gary

AU - Curtis, Eleanor E.

AU - Haan, James

AU - Coimbra, Raul

AU - Bohan, Phillip

AU - Gale, Stephen

AU - Bendix, Peter G.

AU - Lewis, Richard H.

AU - Todd, S. Rob

AU - Hicks, Rachel E.

AU - Victorino, Greg

AU - Scalea, Thomas M.

AU - Guillamondegui, Oscar

AU - Agrawal, Vaidehi

AU - Coleman, Julia R.

AU - Martin, Matthew J.

AU - McCarthy, Cullen K.

AU - Kim, Dennis

AU - Bauman, Zach M.

AU - Galante, Joseph

AU - Lightwine, Kelly

AU - Schreiber, Martin

AU - Allen, Ladonna

AU - Okafor, Barbara U.

PY - 2019/1/1

Y1 - 2019/1/1

N2 - 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.

AB - 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.

KW - Computed tomography

KW - Proctoscopy

KW - Rectal injury

KW - Rectal trauma

KW - Retained foreign body

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DO - 10.1016/j.jss.2019.09.048

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JO - Journal of Surgical Research

JF - Journal of Surgical Research

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