[Management of gunshot injuries of the extraperitoneal rectum]

The aim of this study was to analyze and compare the different lines of surgical management and associated complications of extraperitoneal rectal injuries sustained in Aleppo through Syrian war to get the best one of them. This is a prospective study. Between July 2012 and July 2014, 31 patients with gunshot injuries to the extraperitoneal rectum were treated at the Aleppo University Hospital. Patients with only intraperitoneal rectal injuries were not included in the study. The surgical management of rectal injuries was evaluated, specifically looking at the utilization of proximal diversion, distal washout, and presacral drainage. Complications were compared between the different lines of surgical management. Thirty one patients who sustained penetrating rectal injuries were included in this study. Surgical management included diversion and presacral drainage in 17 patients [55%], diversion alone in 9 patients [29%], and diversion, distal washout and presacral drainage in 5 patients [16%]. Complications were identified in 8 patients [26%]. There were two deaths in the study group. In this cohort most cases have been successfully managed by proximal diversion and presacral drainage. We have not seen any additional benefit when distal washout was performed; and we have not closed any extraperitoneal rectal injury because it is unnecessary, very difficult, and may be impossible or cause additional injuries