- Rectal Injury Associated with Pelvic Fracture
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Jihun Gwak, Min A Lee, Byungchul Yu, Kang Kook Choi
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J Trauma Inj. 2016;29(4):201-203. Published online December 31, 2016
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DOI: https://doi.org/10.20408/jti.2016.29.4.201
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- Rectal injury is seen in 1-2% of all pelvic fractures, and lower urinary tract injury occurs in up to 7%. These injuries are rare, but if missed, can lead to a severe septic response.
Rectal injury may be suspected by the presence of gross blood on digital rectal examination. However, this classic sign is not always present on physical examination. If an Antero-Posterior Compression type pelvic fracture is seen, we should consider the possibility of rectal and lower urinary tract injury. It is important to define the anatomic location of the rectal injury as it relates to the peritoneal reflection. Trauma to the intraperitoneal rectum should be managed as a colonic injury. Extraperitoneal rectal injury should be managed with fecal diversion regardless of primary repair.
We present the case of a 46-year-old man who was referred to our hospital following a major trauma to the pelvis in a pedestrian accident.
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Citations
Citations to this article as recorded by  - Rectal Perforation Associated with a Pelvic Fracture Managed with Lateral Caudal Axial Pattern Flap Surgery Using the Tail to Skin Defect in a Mixed-Breed Dog
Jongjin Lee, Jinsu Kang, Namsoo Kim, Suyoung Heo
Journal of Veterinary Clinics.2021; 38(5): 240. CrossRef
- Enteroatmospheric Fistula Associated with Open Abdomen
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Jihun Gwak, Min A Lee, Dae Sung Ma, Kang Kook Choi
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J Trauma Inj. 2016;29(4):195-200. Published online December 31, 2016
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DOI: https://doi.org/10.20408/jti.2016.29.4.195
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- Enteroatmospheric fistula (EAF) is one of the most devastating complications in patients with an open abdomen and has associated morbidity and mortality rates. No gold standard therapy has been established for the treatment of EAF, and thus, treatment decision making is dependent on the experience of medical staff. Nevertheless, treatment involves the following; 1) sepsis must be managed, 2) sufficient nutritional support must be provided, and 3) effluent must be isolated from skin and open viscera. Here the authors present the case of a 29-year-old man who developed enteroatmospheric fistula after damage control laparotomy.
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Citations
Citations to this article as recorded by - From an Enteroatmospheric to an Enterocutaneous Fistula Using a Condom
Sofia Gaspar Reis, Patrícia Bernardo, Nuno Mendonça, Hélder Além, Zara Caetano
Cureus.2024;[Epub] CrossRef
- Blush on Computed Tomography and Transcatheter Arterial Embolization in Pelvic Fracture
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Jihun Gwak, Yong Cheol Yoon, Min A Lee, Byungchul Yu, Myung Jin Jang, Kang Kook Choi
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J Trauma Inj. 2016;29(4):161-166. Published online December 31, 2016
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DOI: https://doi.org/10.20408/jti.2016.29.4.161
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Bleeding is the primary cause of death after severe pelvic fracture. Transcatheter arterial embolization (TAE) is the mainstay of treatment for arterial bleeding. This study aimed to determine the frequency of bleeding by angiography of blush-positive pelvic fractures on computed tomography (CT) images. The bleeding arteries that were involved were investigated by pelvic angiography.
METHODS
This retrospective cohort study evaluated 83 pelvic fracture patients who were treated in the intensive care unit of the author's trauma center between January 01, 2013 and April 30, 2015.
RESULTS
Overall mortality was 9 of 83 patients (10.8%). Blush was observed in 37 patients; blush-positive patients had significantly higher mortality (24.3%) than blush-negative patients (0%). Twenty-four of the 83 patients (28.9%) underwent pelvic angiography. Bleeding was showed in 22 of 24 patients in pelvic angiography. TAE was successfully performed in 21 (95.5%) of the bleeding 22 patients. Angiography was performed in 23 of 37 blush-positive patients, and arterial bleeding was identified in 21 (91.3%). A total 33 bleeding arteries were identified in 22 angiography-positive patients. The most frequent origin of bleeding was internal iliac artery (69.7%) followed by the external iliac artery (18.2%) and lumbar arteries (12.1%).
CONCLUSION
The vascular blush observed in CT scans indicates sites of ongoing bleeding in pelvic angiography. TAE is an excellent therapeutic option for arterial bleeding and has a high success rate with few complications.
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