Management of Pediatric Rectal Trauma: A Four-Year ACS-TQIP Database Review.

Authors

Omar Obaid, Tania Torres-Ruiz, Cory Criss, Brian Kenney, Matthew Ralls, Marcus Jarboe, James Geiger, Robert N Cotterman

Published in

Journal of pediatric surgery. Pages 163373. Aug 07, 2026. Epub Aug 07, 2026.

Abstract

Adult rectal trauma management has shifted away from fecal diversion, distal rectal washout (DRW) and presacral drainage (PSD) towards primary repair alone, but there is scarce data on children. This study aims to assess the nationwide management of pediatric rectal trauma, its outcomes, and the impacts of the surgical techniques described.
Retrospective review of the ACS-TQIP database 2017-2020. Children with rectal injuries (rectal-AIS≥2) were included. Operative management included trans-anal repair (TAnR), transabdominal repair (TAbR), diverting colostomy (DC), DRW, PSD, and resection (LAR); endoscopy (Endo) was assessed as a predominantly diagnostic procedure. Outcomes included infectious complications, unplanned return to OR, unplanned ICU admission, mortality, and length-of-stay (LOS). Multivariate binary logistic regression analyses were performed to identify independent predictors of DC, and the effect of surgical techniques on outcomes.
641 children were included. Mean age was 11±5 years, 62% were male, 65% were blunt injuries, and median ISS was 8 (IQR 4-16). Concomitant injuries included pelvic fracture (21%), small bowel (15%), and colon (15%). Overall, 43% of patients underwent operative intervention, while 31% underwent diagnostic endoscopy. Outcomes were: 2% infectious complications; 3% unplanned return to OR; 1% unplanned ICU admission; 3% mortality; 4 [2-8] days LOS. Higher rectal AIS was the only predictor of DC. Age 6-12 years (lower odds) and higher rectal AIS (higher odds) were independently associated with the composite adverse outcome.
This is the largest cohort study of pediatric rectal trauma to date. The majority (57%) were managed non-operatively, consistent with a contemporary practice pattern of selective operative management. When surgery was pursued, primary repair was much more common than fecal diversion, DRW or PSD. The surgical technique was not independently associated with outcomes after adjusting for confounders.

PMID:
42567261
Bibliographic data and abstract were imported from PubMed on 08 Aug 2026.

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