Rectal Injury

Question 1

What Supplies the Rectum

Answer 1

superior, middle rectal, and inferior rectal arteries that branch off the inferior mesenteric artery, internal iliac arteries, and internal pudendal arteries, respectively.

Question 2

Venous Drainage of the Rectum

Answer 2

both the portal and systemic circulation

The superior rectal veins draining to the inferior mesenteric veins
the middle and inferior rectal veins draining to the internal iliac and pudendal veins, respectively.

Question 3

Intraperitoneal Vs Extraperitoneal

Answer 3

anterior and lateral upper two-thirds of the rectum are located intraperitoneally and the remainder is extraperitoneal

Question 4

Investigations

Answer 4

DRE
CT With Rectal Contrast
Anorectal exam , Proctosigmoidoscopy

Question 5

Ct Signs of Rectal Injury

Answer 5

discontinuity of the rectal wall
extraluminal enteric contrast originating from the rectum, pneumoperitoneum,
mesenteric air,
free intraabdominal fluid,
bowel wall thickening
mesenteric hematoma.

Question 6

Intreperitoneal Injury management

Answer 6

managed the same as those with colon injuries.

Nondestructive injuries without devitalization of tissue repaired primarily in one or two layers.

If there is significant tissue loss or vascular compromise, resection of the injured segment and Primary anastomosis without diverting colostomy or ileostomy is preferred

If there is Evidence of Shock , or Multiple Injuries
End Colostomy with Closure of rectal Stump

Question 7

Extraperitoneal Injury

Answer 7

Proximal extraperitoneal injuries (posterior aspect of the rectum above the peritoneal reflection) are more likely amenable to primary repair , With or Without Diversion

Distal extraperitoneal injuries (below the peritoneal reflection) , If Accessible Primary repair and Proximal Diversion, If not Accessible Proximal Diversion and Presacral Drainage

Question 8

Management of Anorectal Injuries

Answer 8

A simple laceration to the anal mucosa repaired primarily

complex lesions involving the distal perineum and rectum may require diverting colostomy.

If extensive tissue debridement is required, consideration of :
overlapping sphincteroplasty
transposition of the gluteus or gracilis muscle with creation of a neosphincter,
or abdominoperineal resection

In the case of foreign body insertion, transanal extraction