Name of the Procedure:

Exploration, Repair, and Presacral Drainage for Rectal Injury with Colostomy

Summary

This is a surgical procedure used to treat serious injuries to the rectum. It involves exploring the injured area, repairing any damage, draining the presacral (area in front of the sacrum) space, and creating a colostomy (an opening in the abdominal wall for waste removal).

Purpose

The procedure is aimed at repairing rectal injuries to prevent complications such as infections, abscesses, and chronic pain. The colostomy diverts stool from the injured area, allowing it to heal more effectively.

Indications

• Severe trauma or injury to the rectum, such as from a car accident or a penetrating wound.
• Conditions causing chronic rectal abscesses or infections.
• Presence of severe inflammation or damage that requires bowel diversion for healing.

Preparation

• Patients may need to fast before the procedure.
• Adjustments to current medications may be necessary.
• Pre-operative diagnostic tests, such as CT scans or MRIs, to assess the extent of the injury.

Procedure Description

1. Anesthesia: General anesthesia is administered to ensure the patient is unconscious and pain-free.
2. Exploration: The surgeon makes an incision to access the rectum and pelvis.
3. Repair: Damaged areas of the rectum are identified and repaired surgically.
4. Presacral Drainage: Drains are placed in the presacral space to prevent fluid accumulation and infection.
5. Colostomy: An opening is created in the abdominal wall, and the healthy part of the colon is connected to this opening to divert stool away from the rectum.

Specialized surgical tools, drainage tubes, and colostomy supplies are used throughout the procedure.

Duration

The procedure typically takes 2-4 hours, depending on the extent of the injury and the complexity of the repair.

Setting

The surgery is performed in a hospital operating room.

Personnel

• Surgeon: A specialist in colorectal or trauma surgery.
• Anesthesiologist: Manages anesthesia and patient’s vital signs during surgery.
• Surgical Nurses: Assist with the procedure.
• Operating Room Technicians: Provide technical support.

Risks and Complications

• Common Risks: Infection, bleeding, and reactions to anesthesia.
• Rare Complications: Injury to nearby organs, formation of a fistula (abnormal connection between organs), and non-healing of the repaired tissue.

Management typically involves antibiotics for infections, and further surgical intervention if necessary.

Benefits

• Effective repair of rectal injuries.
• Prevention of serious complications such as sepsis or chronic abscess formation.

• Immediate relief from symptoms related to rectal injury.

  Recovery and healing of the injured area are expected over several weeks.

Recovery

• Post-operative care includes wound care, management of the colostomy, and pain control.
• Patients may stay in the hospital for several days to a week.
• Full recovery can take several weeks to a few months, with ongoing adjustments for colostomy care and routine check-ups.

Alternatives

• Non-Surgical Treatment: Antibiotics and less invasive procedures might be attempted in minor cases but are generally not sufficient for severe injuries.
• Other Surgical Options: Delayed colostomy (if immediate colostomy is not required) or different types of bowel diversion techniques.

Each alternative has different risks and benefits compared to the described procedure, often depending on the injury's severity.

Patient Experience

Patients will be under general anesthesia during the surgery, so they will not feel pain during the procedure. Post-surgery, they might experience discomfort or pain, which will be managed with painkillers. Learning to manage a colostomy can be challenging and may require lifestyle adjustments, but it is manageable with proper support and training.