Concomitant Bladder and Rectal Injuries: Results from the American Association for the Surgery of Trauma (AAST) Multi-Center Rectal Injury Study Group
Combined injuries to the rectum and bladder as a result of trauma are uncommon. We hypothesized that the combination of bladder and rectal injures would have worse outcomes than rectal injury alone.
This is an American Association for the Surgery of Trauma multi-institutional retrospective study from 2004-2015 of all patients who sustained a traumatic rectal injury and were admitted to one of the 22 participating centers. Demographics, mechanism, and management of rectal injury were collected. Patients who sustained a rectal injury alone were compared to patients who sustained a combined injury to the bladder and rectum. The primary outcome was an abdominal complication (combined outcome of: abdominal abscess, pelvic abscess, or fascial dehiscence). Secondary outcomes included mortality and length of stay.
There were 424 patients who sustained a traumatic rectal injury, of which 117 (28%) had a combined injury to the bladder and rectum. When comparing the patients with a combined bladder/rectal injury to the rectal alone group there was no difference in admission demographics but the combined bladder/rectal group more often sustained penetrating trauma (85% vs. 66%, p=0.0002). There was no difference between groups for admission physiology or injury severity score. There was no difference in management of the rectal injury and no difference in abdominal complications (13% vs. 16%, p=0.38), mortality (3% vs. 2%, p=0.68), or length of stay (17 days vs. 21 days, p=0.10). When looking at only the 117 patients with a combined injury, 92 (79%) received a colostomy for management of their rectal injury. Colostomy patients more often sustained penetrating trauma (91% vs. 60%, p<0.0001) but there was no difference in admission physiology or injury severity score. The addition of a colostomy did not decrease the rate of abdominal complications (14% vs. 8%, p=0.42), mortality (3% vs. 0%, p=0.99), or length of stay (17 days vs. 17 days, p=0.94).</p>
For patients with traumatic rectal injury, a concomitant bladder injury does not increase the rates of abdominal complications, mortality, or length of stay. Furthermore, the addition of a diverting colostomy for management of traumatic rectal injury does not decrease the rate of abdominal complications, mortality, or length of stay for patients with combined injuries to the rectum and bladder.