Table 7

Rectal injuries

QuadrantInjuryManagement
LIExtraperitoneal, anterior+posterior rectal injury, >25% circumference.Diagnostic laparoscopy+defunctioning ileostomy. Reversed 5 months later.
LIExtraperitoneal injury at 5 o’clock position, <25% circumference, some division of sphincter.Rectum sutured+drain inserted. Diagnostic laparoscopy normal.
LISuspected extraperitoneal rectal injury <25% circumference.
Intramural blood, blood, and feces obscuring view on RS, large mesorectal hematoma on diagnostic laparoscopy.
Laparoscopic loop colostomy, reversed 3 months later.
LIAnal sphincter injury, <25% circumference.Washout+packing.
UIExtraperitoneal injury, 25% of circumference, 6–9 o’clock 8 cm from anal verge.Laparoscopic loop colostomy. Reversed 6 months later.
LIExtraperitoneal, laceration 2 cm from anal verge extending radially to around 4 cm, <25% circumference. External anal sphincter fibers seen.EUA+packing of rectum+RS+second look EUA.
  • EUA, examination under anesthetic; LI, lower inner; RS, rigid sigmoidoscopy; UI, upper inner.