Introduction

The colon is the second most commonly injured organ in penetrating trauma, but injury is rare in blunt trauma (2-5%). However rectal injuries are more common in blunt trauma, especially when associated with pelvic injuries. Diagnosis of these injuries may be difficult - especially in the unconscious or obtunded patient. Maintaining a high degree of suspicion is vital to avoid missing these injuries.

Colon & Rectum

Introduction
Diagnosis
Management - History
Management - Colon
Management - Rectum
Management - Guidelines
References

Case Presentation: Missed rectal injury

A 22 year old man presented to the trauma centre 3 days following a stab wound to the right buttock. He had initially been seen at another hospital where a 1.5cm wound to the outer aspect of the right buttock had been cleaned and stitched. He represented due to pain in the buttock and appearance of a 4cm black patch around the buttock wound. He had never complained of any rectal pain or bleeding.

Examination at the trauma centre included digital rectal examination and rigid sigmoidoscopy/proctoscopy, revealing some blood and pus and an injury to the lateral rectal wall. The patient was transferred immediately to the operating room for debridement of the buttock wound and defunctioning colostomy. On the operating table the nectroci patch on the buttock had expanded to approximately 8cm in diameter. Debridement was commenced but could not keep pace with the rapidly spreading necrotizinf fasciitis.

The patient eventually died on the operating table when it became apparent the sepsis had spread to include his upper and lower limbs.

Diagnosis