1 / 53

Colon & Rectum Injuries

Colon & Rectum Injuries. Prayuth Sirivongs M.D. COLONIC INJURIES. Anatomy Cecum Ascending colon Transverse colon Descending colon Sigmoid colon. Etiology Penetrating Injury : Gun Shot ~ 75% Stab wound ~ 20% Blunt Injury : Motor vihicle

kenyon-hendrix
Download Presentation

Colon & Rectum Injuries

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Colon & Rectum Injuries Prayuth Sirivongs M.D.

  2. COLONIC INJURIES Anatomy • Cecum • Ascending colon • Transverse colon • Descending colon • Sigmoid colon

  3. Etiology Penetrating Injury : Gun Shot ~ 75% Stab wound ~ 20% Blunt Injury :Motor vihicle Trananal Injury : Iatrogenic ; colonoscopy ,B.E. Sexual related : foreign body COLONIC INJURIES

  4. Diagnosis Pre-operation Blood in rectum Acute abdomen series Water soluble contrast enema Triple contrast CT COLONIC INJURIES

  5. COLONIC INJURIES Intra operation Rule of “ two “ Complete mobilize Blood staining Fecal odorsegmental squeeze

  6. Treatment Colostomy Exteriorized repair primary repair COLONIC INJURIES

  7. colostomy End Colostomy Protective Colostomy COLONIC INJURIES

  8. colostomy End Colostomy Protective Colostomy COLONIC INJURIES

  9. Indication for colostomy ( Stone & Fabian) 1.Shock c BP<80/60 mmHg 2.Intraperitoneal blood loss > 1000 ml 3.Intra-abdominal organ injuries > 2 organs 4.Significant fecal contamination 5.Time to operation >8 hrs 6.Colonic wound require resection 7.Major loss abdominal wall /Mesh COLONIC INJURIES

  10. Colonic Injury Severity score(Shanon&Moore) Grade 1 ; Serosal injury Grade 2 ; Single wall injury Grade 3 ; < 25% wall involvement Grade 4 ; > 25% wall involvement Grade 5 ; Whole colonic wall involvement and blood supply injury COLONIC INJURIES

  11. Exteriorized repair Avoided resection Reduced contamination Reduced colostomy Limited in some part of colon Stomal care is more difficult than colostomy COLONIC INJURIES

  12. Primary repair Sutured repair Resection with primary anatomosis COLONIC INJURIES

  13. Primary repair Sutured repair Resection with primary anatomosis COLONIC INJURIES

  14. Primary repair Avoid colostomy Less morbidity than colostomy Gained more popularity Having high risk in patient c underlying medical illness massive blood transfusion COLONIC INJURIES

  15. outcome cause of death exanguination sepsis ; intra- abdominalabscess multi organ failure fistula (primary repair) COLONIC INJURIES

  16. Anatomy Promontary of sacrum to anus intraperitoneal extraperitoneal Length ~12-20 cm. RECTAL INJURIES

  17. Anatomy Anal canal Anorectal ring to anal verge Sphincter complex puborectalis muscle external sphincter internal sphincter RECTAL INJURIES

  18. Etiology Penetrating injuries ; gun shot ~80% Stab & impalement <5% Blunt injury ~ 10% Transanal injury ; ~ 6% Anal intercourse Anal rape Iatrogenic ; enema, thermometer RECTAL INJURIES

  19. Diagnosis Suspected in GSW ; Trunk , buttock , perineum upper thigh Stab ; buttock , perineum , lower abdomen Blood in rectum ( rectal exam ) RECTAL INJURIES

  20. Investigation X-ray pelvis & abdomen; bullet tract,foreign body, fracture pelvis Rigid proctosigmoidoscope Water soluble contrast study RECTAL INJURIES

  21. Treatment 1.Intraperitoneal rectal injuries;as colonic injuriession 2.Extraperitoneal rectal injuries ; Diversion Debridement Distal washout Presacral drainage RECTAL INJURIES

  22. Diversion 1. Loop colostomy 2 .Loop colostomy c stapling distal lumen 3 .End colostomy c mucous fistula 4 .Hartmann’s procedure RECTAL INJURIES

  23. Diversion 1. Loop colostomy 2 .Loop colostomy c stapling distal lumen 3 .End colostomy c mucous fistula 4 .Hartmann’s procedure RECTAL INJURIES

  24. Diversion 1. Loop colostomy 2 .Loop colostomy c stapling distal lumen 3 .End colostomy c mucous fistula 4 .Hartmann’s procedure RECTAL INJURIES

  25. Diversion 1. Loop colostomy 2 .Loop colostomy c stapling distal lumen 3 .End colostomy c mucous fistula 4 .Hartmann’s procedure RECTAL INJURIES

  26. 2. Debridement : removed devitalize tissue repair defect if possible severe injury ; resection 3.Distal washout : decrease septic complication RECTAL INJURIES

  27. 4.Presacral drainage RECTAL INJURIES

  28. Outcome Cause of death: Sepsis, Multi-organ failure Anorectal abscess Rectal fistula RECTAL INJURIES

  29. PERINEAL INJURIES • Perineum • Inferior end of trunk • Anterior (urogenital) • Genital organ • Urethra • Posterior (anal) • Anus

  30. PERINEAL INJURIES MALE FEMALE

  31. PERINEAL INJURIES ETIOLOGY : Iatrogenic anorectal injury Traumatic anorectal injury Foreign bodies in rectum Anal intercourse & assult

  32. PERINEAL INJURIES IATROGENIC INJURIES • Obstetric injury • Anorectal surgery • Enema • Rectal thermometer • Urologic & Gynecologic surgery

  33. PERINEAL INJURIES TRAUMATIC INJURIES • Blunt injury • Straddle injury • Laceration • Implement • Gunshot wound • Blast • High pressure

  34. PERINEAL INJURIES MANAGEMENT • Primary survey • Resuscitation • Secondary survey • Definitive care

  35. PERINEAL INJURIES SECONDARY SURVEY • History taking • Cause of injury • Mechanism of injury • Duration of injury • Associated injury • Symptom & sign • Perineal pain • Lower abdominal pain • Bleeding • Sepsis

  36. Perineum , anus , buttock , thigh • Abdomen • Digital rectal examination • Associated injuries • Vagina • Urethra & prostate gland • pelvis PERINEAL INJURIES SECONDARY SURVEY examination

  37. PERINEAL INJURIES INVESTIGATION • Film abdomen supine ,upright , lateral • Rigid sigmoidoscopy • Contrast study

  38. PERINEAL INJURIES TREATMENT • Perineal injury with rectal injury • Debridement • Diversion • Drainage • Distal washout

  39. PERINEAL INJURIES TREATMENT • Perineal injury • Small hematoma ; conservative • Expanded hematoma ; evacuated blood • Laceration ; debridement & stop bleeding • Severe laceration ; debridement , stop bleeding and colostomy

  40. PERINEAL INJURIES TREATMENT • Perineal injury • Debridement • Adequate debridement • Left wound open • Frequent debridement • Adequate pain control • Control contamination

  41. PERINEAL INJURIES TREATMENT • Perineal injury with anal sphincter injury • minimal sphincter injury • severe sphincter injury • colostomy • primary repair • non primary repair

  42. PERINEAL INJURIES TREATMENT • Incontinence • Sphincteroplasty • Muscle transposition • Artificial sphincter

  43. ANAL INTERCOURSE • Mostly in Homosexual • Complication • Retained foreign bodies • Colorectal perforation • Anal tear • Digital rectal exam & sigmoidoscopy

  44. ANAL INTERCOURSE • Management • Uncomplicated injury • Warm sitz bath • Stool softener • Tropical analgesic preparation

  45. ANAL INTERCOURSE • Management • Surgery • Deep tear • Perforation • Sphincter injury • Persistent bleeding

  46. FOREIGN BODIES IN RECTUM • Oral ingested • Bones • Toothpick • Seeds • Anal insertion • Sex toys • Bottles • Cans • Flashlights • Fruit • umbrella

  47. FOREIGN BODIES IN RECTUM • Age ; 20-30 yrs and more than 60 yrs. • Male : female 25: 1 • Classification • Retained F.B. without injury • Non perforative mucosal laceration • Sphincter injury • Rectosigmoid perforation

  48. FOREIGN BODIES IN RECTUM • History • Symptom & sign • Anal or pelvic pain • Inability to remove F.B. • Bleeding • Peritonitis

  49. FOREIGN BODIES IN RECTUM • Physical examination • Abdomen • Digital rectal exam • Investigation • Film abdomen AP& Lateral • Contrast study

  50. FOREIGN BODIES IN RECTUM • Management • Bedside extraction • Local anesthesia • Valsava maneuver • Sedation • Observation

More Related