Rectal Trauma

Rectal Trauma is a topic covered in the 5-Minute Emergency Consult.

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  • Injury to rectal mucosa
  • Simple contusion to full-thickness laceration with extension into peritoneum or perineum
  • 2/3 of rectum is extraperitoneal.


  • Penetrating trauma:
    • Gunshot wounds: 80% penetrating rectal trauma
    • Knife wounds
    • Impalement injuries
  • Blunt trauma:
    • Motor vehicle accidents
    • Waterskiing and watercraft accidents:
      • Hydrostatic pressure injury
    • Pelvic fractures:
      • Bony fragments penetrate rectum
  • Foreign body:
    • Autoeroticism
    • Anal intercourse
    • Assault
    • Ingestion of sharp objects
  • Iatrogenic trauma: Most common cause of rectal injury:
    • Barium enema:
      • Perforation occurs in 0.04% patients
      • 50% mortality
    • Colonoscopy:
      • 0.2% perforation rate
      • Increased risk with polypectomy
    • Hemorrhoidectomy
    • Urologic and Ob-Gyn procedures:
      • Episiotomy

Pediatric Considerations
  • Rectal injury may result from thermometer insertion.
  • Any rectal trauma in young children should raise the suspicion of nonaccidental trauma.

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