Current Management of Rectal Injury and Injured Spleen

Vocabulary flashcards reviewing the anatomical principles, grading, diagnostic workup, and management of traumatic rectal injuries and splenic trauma.

Rectum

The distal continuation of the colon, measuring $12\text{ to }15\,\text{cm}$ in length, extending from the rectosigmoid junction to the dentate line.

Superior Rectal Artery

The terminal continuation of the inferior mesenteric artery that supplies the upper third of the rectum.

Middle Rectal Arteries

Arteries arising from the internal iliac arteries that supply the middle third of the rectum.

Inferior Rectal Artery

A branch from the internal pudendal artery supplying the distal third of the rectum.

Venous Drainage of the Rectum

Dual drainage into both portal and systemic systems: superior rectal veins drain to inferior mesenteric veins (portal), while middle and inferior rectal veins drain to internal iliac and pudendal veins, respectively (systemic).

Extraperitoneal Rectum

Anatomical region comprising the posterior aspect of the rectum (adherent to presacral soft tissue) and the lower one-third of the anterior portion.

Intraperitoneal Rectum

Anatomical region comprising the upper two-thirds of the anterior portion and the lateral rectum.

AAST Rectal Injury Grade I

Contusion or hematoma without devascularization, or a partial-thickness laceration.

AAST Rectal Injury Grade II

A rectal laceration involving $<50\%$ of the circumference.

AAST Rectal Injury Grade III

A rectal laceration involving $\ge 50\%$ of the circumference.

AAST Rectal Injury Grade IV

A full-thickness rectal laceration with extension into the perineum.

AAST Rectal Injury Grade V

A devascularized segment of the rectum.

Digital Rectal Examination (DRE) in Rectal Trauma

Initial diagnostic examination where gross blood is present in $90\%$ of rectal injuries and a palpable defect approaches $100\%$ specificity for diagnosing rectal injury.

Rectal Contrast CT Utility

A diagnostic imaging technique with a sensitivity of only $12\%$ and a false-negative rate of $88\%$ for rectal injuries; routine administration is not recommended.

Combined CT Scan and Endoscopy

Diagnostic combination of CT scan and proctosigmoidoscopy that yields a sensitivity of $97\%$ for diagnosing rectal injuries.

Nondestructive Intraperitoneal Rectal Injury Repair

Primary repair of AAST Grade I–III injuries performed in a transverse orientation with two layers: a full-thickness running absorbable suture followed by interrupted seromuscular sutures.

Destructive Rectal Injury

Rectal injury characterized by devascularized tissue, association with mesenteric injury, large or irregular wall defects, or extensive bowel wall damage.

Historic Management of Extraperitoneal Rectal Wounds

The former practice of distal rectal washout and presacral drainage, which is no longer recommended.

Transanal Foreign Body Extraction

Initial non-operative approach for rectal foreign body removal under adequate sedation and lubrication, successful in $70\%$ of patients.

Delayed Primary Closure in Rectal/Colonic Trauma

Wound management approach performed $3\text{ to }5\,\text{days}$ after initial surgery to prevent wound infections, which occur in up to $50\%$ of patients if primary skin closure is attempted.

Kehr Sign

Referred left shoulder pain resulting from diaphragmatic irritation, indicating potential splenic injury.

Intraperitoneal and Extraperitoneal Rectal Divisions Diagram

Diagram showing the anatomical breakdown of the rectum into Intraperitoneal (IP) and Extraperitoneal (EP) divisions, with EP further divided into Proximal EP and Distal EP.

Penetrating Rectal Injury Management Algorithm Diagram

Decision tree illustrating management pathways for penetrating rectal injury based on intraperitoneal versus extraperitoneal location, upper two-thirds vs lower one-third, and wound accessibility.