TY - CHAP M1 - Book, Section TI - Colon and Rectum A1 - Croce, Martin A. A1 - Fabian, Timothy C. A2 - Feliciano, David V. A2 - Mattox, Kenneth L. A2 - Moore, Ernest E. PY - 2020 T2 - Trauma, 9e AB - KEY POINTSThe presence of blood on digital examination of the anorectum is highly suggestive of injury, but its absence does not rule out injury to the colon or rectum.Primary repair of colonic injuries is safe and is the preferred option for nondestructive wounds.The management of patients with destructive colon wounds is controversial, but a prudent approach would be resection and anastomosis for stable patients without shock or other major comorbidities and diversion for unstable or high-risk patients.Degree of fecal contamination influences the probability of developing septic complications, including intra-abdominal abscess, but is not associated with an increased risk of suture line failure (anastomotic leaks).Patients with intraperitoneal penetrating rectal injuries should be managed the same as those with colon injuries. In patients with blunt injuries, proximal colostomy is usually the procedure of choice, as these injuries are frequently associated with pelvic fractures or complex perineal injuries.Extraperitoneal rectal injuries should be managed according to the anatomy of the injury. If the injury is accessible, it may safely be repaired primarily without diversion. If it cannot be repaired, then diversion is indicated.The anatomy of the rectal injury should dictate whether presacral drains be placed (selective use), but the practice of rectal washout cannot be supported by contemporary data. SN - PB - McGraw Hill CY - New York, NY Y2 - 2024/03/29 UR - accesssurgery.mhmedical.com/content.aspx?aid=1175138647 ER -