Comprehensive Management of Combat-Related Rectal Injuries: A Case Series of the Role of Endoscopic and Surgical Interventions on Diagnosis, Management, and Outcomes
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Abstract
Rectal injuries are significant in wartime trauma, occurring in 5-6% of cases, often associated with explosive injuries. These injuries rarely occur in isolation due to the rectum's proximity to other pelvic organs, complicating diagnosis and treatment. This case series examines combat-related rectal injuries in military personnel, focusing on diagnostic challenges, operative management, and postoperative care. Three cases of combat-related rectal injuries caused by transpelvic explosive and gunshot wounds are presented, highlighting the use of laparotomy, colonoscopy, colostomy, wound debridement, and endoscopic clipping. Mortality and complication rates of rectal injuries in wartime are 3-10% and 18-21%, respectively. Effective management protocols such as the "FOUR Ds" (Debridement, Diversion, Drainage, Distal Washout) have evolved through conflicts from World War I to the present. Our case series illustrates the importance of prompt surgical interventions and the use of modern techniques like colonoscopy and endoscopic clipping in the successful treatment of combat-related rectal injuries. All patients in this series had uneventful recoveries following surgical intervention.
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