Initial management for rectal injuries include protoctoscopy to definite
extent of the trauma and diversion colostomy. Stool should be evacuated from
the distal rectum at the time of operation. Patients with significant rectal injuries
should be monitored for local and systemic infections. Wound management of
these patients may be complex.
Injuries to the duodenum merit special discussion. The most common
mechanism of injury resulting in duodenal injury is blunt abdominal trauma
[49,50]. In younger patients, the finding of a duodenal injury is often the result
of non-accidental trauma and should raise suspicion if the history or
mechanism is inconsistent with the injury [51,52].^ Due to its anatomic
relationship to many other vital structures, associated injuries may be seen.
Abdominal CT is the imaging modaility that best evaluates duodenal injuries.
Duodenal injuries are graded by the AAST and range from grade 1 (hematoma)
to grade 5 (devascularization of the duodenum or massive disruption of the
duodenopancreatic complex) [53].
The spectrum of duodenal injuries include mild duodenal hematomas
with transmural thickening, moderate partial thickness injuries with partial to
total obstruction to transmural injuries. If no clinical or radiologic evidence of
perforation, exist duodenal injuries should be managed nonoperatively with
nasogastric decompression and TPN [54]. Though rare, operative evacuation
of the hematoma may be required if obstructive signs and symptoms do not
resolve. Duodenal perforation is often a delayed diagnosis due to a delay in