Mechanism matters with traumatic rectal injuries: Multicenter analysis of blunt versus penetrating traumatic rectal injury management and associated outcomes

doi:10.1016/j.amjsurg.2026.117223

Mechanism matters with traumatic rectal injuries: Multicenter analysis of blunt versus penetrating traumatic rectal injury management and associated outcomes

Journal: American journal of surgery (Q1)
Published: 25 September 2026
Study design: Unclassified
Evidence level: Level 5, Expert Opinion (CEBM 5)
Authors: Christine Isabella Bent, Vanya Vojvodic, Negar Nekooei, Monica D Wong, Anaar E Siletz, Kazuhide Matsushima, et al.
PMID: 42868920
DOI: 10.1016/j.amjsurg.2026.117223

Why clinicians should know about it

Picked for Surgery (paper of the day, 19 October 2026): Traumatic rectal injury management outcomes

Abstract

OBJECTIVE: Examine the impact of injury mechanism and management strategies on outcomes after traumatic rectal injury (TRI). BACKGROUND: TRI are uncommon, with most data derived from penetrating injuries. Whether management and outcomes differ between blunt (BR) and penetrating (PR) injuries remains unclear. METHODS: A multicenter study across 22 trauma centers compared management patterns, use of the "4 Ds" adjuncts (drain, diversion, distal washout, direct repair), and outcomes between BR and PR. RESULTS: Among 725 patients (511 PR, 214 BR), BR had higher injury severity, more abdominal complications, and required more interventions despite similar TRI grade. Mortality was lowest in PR managed with adjuncts and highest in BR without adjuncts. In BR, diversion-only management resulted in the highest complication and reintervention rates. Drain and distal washout were also associated with increased abdominal complications. Multivariable analysis showed diversion-only management independently increased complications versus primary repair. CONCLUSION: BR carry greater morbidity than PR and may favor repair strategies.

Abstract as published, via PubMed.

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For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.