@article{ref1,
title="Diversion Remains the Standard of Care for Modern Management of War-Related Rectal Injuries",
journal="Military medicine",
year="2014",
author="O'Donnell, Mary T. and Greer, Lauren T. and Nelson, Jeffery and Shriver, Craig and Vertrees, Amy",
volume="179",
number="7",
pages="778-782",
abstract="INTRODUCTION: Management of rectal injuries in war-injured patients has evolved over time. <br><br>METHODS: Retrospective review of records of patients sustaining war-related rectal injuries admitted to Walter Reed Army Medical Center from Iraq and Afghanistan. <br><br>RESULTS: From 2003 to 2011, 67 males ages 18 to 40 sustained rectal injuries after secondary blast (64%), gunshot (33%), motor vehicle crash (1%), or helicopter crash (1%). Injuries were extraperitoneal (72%), intraperitoneal (25%), or both (3%). Rectal abbreviated injury score mean was 3 ± 1. Surgical management included end colostomy (66%), loop colostomy (28%), and no diversion (4%). Distal washout (24%) and drain placement (33%) were performed. Colostomy closure occurred in 79% of patients at an average of 237 days after injury. <br><br>CONCLUSIONS: Diversion is the preferred treatment of war-related rectal injuries. Loop colostomy is acceptable unless there is potential for evolving rectal injury. Routine use of presacral irrigation and drainage was not supported.<p /><p>Language: en</p>",
language="en",
issn="0026-4075",
doi="10.7205/MILMED-D-13-00533",
url="http://dx.doi.org/10.7205/MILMED-D-13-00533"
}