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

What is indicated for high extraperitoneal rectal trauma with injuries greater than 50%?

1. End ostomy for shock

2. Primary repair without diversion

3. Low anterior resection with loop ostomy

4. Conservative management

The correct answer is: Low anterior resection with loop ostomy

In cases of high extraperitoneal rectal trauma with injuries exceeding 50%, the recommended approach is typically low anterior resection with loop ostomy. This surgical strategy is endorsed due to the complexity and severity of the injury, which often compromises the rectal wall and may lead to significant dysfunction or complications if treated conservatively or with less invasive measures. The rationale for choosing low anterior resection involves removing the damaged portion of the rectum to ensure proper healing and minimizing the risk of infection or fistula formation. Incorporating a loop ostomy allows for temporary diversion of fecal matter away from the healing rectal stump, thereby reducing fecal contamination while the anastomosis heals. This dual approach is vital in managing significant pelvic injuries that can entail substantial risk of complications. In contrast, primary repair without diversion may not adequately address the extent of the damage, risking complications such as leakage and peritonitis. Similarly, end ostomy for shock may be more appropriate in cases where immediate fecal diversion is necessary due to life-threatening circumstances, but it does not consider the long-term management of rectal injuries. Conservative management is typically reserved for minor injuries and would not be suitable for cases with extensive damage, as it could lead to severe complications.