首页   按字顺浏览 期刊浏览 卷期浏览 The Role of Presacral Drainage in the Management of Penetrating Rectal Injuries
The Role of Presacral Drainage in the Management of Penetrating Rectal Injuries

 

作者: Richard P. Gonzalez,   Mark E. Falimirski,   Michele R. Holevar,  

 

期刊: The Journal of Trauma: Injury, Infection, and Critical Care  (OVID Available online 1998)
卷期: Volume 45, issue 4  

页码: 656-661

 

ISSN:0022-5282

 

年代: 1998

 

出版商: OVID

 

数据来源: OVID

 

摘要:

PurposeTo compare in a randomized, prospective manner infectious complication rates associated with presacral drainage versus no drainage in the presence of penetrating rectal injury.MethodsDuring a 45-month period, 48 patients with penetrating rectal injuries were entered into a randomized, prospective study at an urban Level I trauma center. The patients were randomized to a presacral drainage group or a nondrainage group. Randomization was performed after detection of the rectal injury. Forty-four injuries were identified by proctoscopy (92%), with the rest detected intraoperatively or by physical examination. All patients with rectal injuries were included regardless of age, associated injuries, time from injury to operation, blood loss, severity of rectal injury, other abdominal organs injured, or hemodynamic stability. Rectal injuries were defined as those injuries to the large bowel distal to the peritoneal reflection. All rectal injuries underwent fecal diversion, and all drainage was accomplished using closed Jackson-Pratt drainage.ResultsForty-eight patients were studied, of whom 25 were randomized to no drainage and 23 were randomized to presacral drainage. The average age for the nondrainage group was 21.9 years, and the average age for the presacral drainage group 26.0 years. The average Penetrating Abdominal Trauma Index score was 34.3 for the nondrainage group and 32.4 for the presacral drainage group. There were two (8%) septic complications (one perirectal and one perivesical abscess) associated with the rectal injuries in the presacral drainage group. The abscesses in the drainage group resolved after computed tomography-guided drainage. There was one (4%) septic complication (rectocutaneous fistula) in the nondrainage group, which was associated with a retained missile fragment. The fistula resolved after bedside percutaneous removal of the missile fragment.ConclusionWe conclude that presacral drainage for penetrating rectal injuries has no effect on infectious complications associated with the rectal injuries.

 



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