American Board of Surgery Qualifying Exam (ABS QE) Practice Test

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In the case of intra-peritoneal rectal trauma, what is the guideline for injuries less than 50%?

End ostomy for shock
Primary repair without diversion
Low anterior resection with loop ostomy
Exploratory laparotomy

The correct answer is: Primary repair without diversion

In cases of intra-peritoneal rectal trauma, when the injury is assessed to be less than 50%, the guideline is to perform a primary repair without diversion. This approach is endorsed because when damage is limited, the integrity of the rectal wall can often be preserved adequately to allow for direct repair. Choosing primary repair is preferred when the injury does not involve extensive tissue loss, contamination, or involve significant compromise to vascular supply. Avoiding diversion (such as ostomy) helps maintain normal gastrointestinal continuity and reduces the potential complications associated with ostomy creation. On the other hand, diversion is more appropriate for severe injuries or those presenting with shock, where the risk of pelvic sepsis and contamination is higher. In summary, primary repair without diversion is considered safe and effective for rectal injuries less than 50%, facilitating recovery and minimizing the need for more invasive procedures that could arise from complications.