Naveed Ahmed, Rapheal Chung.
Rigid vs. flexible Endoscopy for evaluation of penetrating rectal injuries.
J Coll Physicians Surg Pak Jan ;17(12):769-70.

The study, approved by IRB, was done in a busy trauma service. Initial RS was performed in the trauma bay on all stable patients suspected of penetrating rectal trauma due to Gun Shot Wounds (GSWs) of abdomen and pelvis. A FS was then performed in the operating room before operation. Findings at RS and FS were recorded as direct signs or indirect signs of injury to the rectum. Absence of direct or indirect signs of rectal trauma on FS, ruled out rectal injury and laparotomy was only performed, if other injuries mandated it. Presence or absence of rectal injury was then confirmed at exploration. Ten patients were included in the study over a period of three years. All patients were hemodynamically stable and had low velocity handgun wounding, suspicious for rectal injury. RS did not visualize direct (sign of actual injury) in any patient. In 4 patients, RS showed indirect signs (blood in rectum). In 6, RS was inconclusive due to incomplete visualization (fecal loading) or possibility that blood in the rectum was dragged in at the time of procedure. FS ruled out rectal injury in 2 patients, one of them was explored for other injuries, neither of them had rectal injury. Rectal injury was found in 8 patients on FS in 5, there was direct visualization. One patient with intraperitoneal rectal injury had primary repair without diversion. Rest were managed with a loop diverting colostomy with stapled efferent limb without repair of low rectal injuries or presacral drainage and rectal pouch was not aggressively cleared.

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