Reserved for high-risk patients (e.g., severe shock, multiple blood transfusions, significant contamination). 2. Extraperitoneal Injuries (Below the Reflection)

Management of these injuries is more controversial but has moved away from the "4-D" algorithm (Divert, Drain, Distal washout, Direct repair). Rectal Trauma - StatPearls - NCBI Bookshelf - NIH

The management of penetrating rectal injuries has evolved from rigid wartime protocols to more selective, evidence-based approaches. Modern care is dictated by the (intraperitoneal vs. extraperitoneal) and the hemodynamic stability of the patient. 🏥 Initial Assessment & Diagnosis

Often used in the operating room to visualize the extent and exact level of the injury. Surgical Management Principles

For more extensive tissue destruction.

Contemporary practice distinguishes between injuries above and below the peritoneal reflection. 1. Intraperitoneal Injuries (Above the Reflection) These are treated similarly to colonic injuries :