DIAGNOSTIC AND TREATMENT STRATEGY FOR GUNSHOT INJURIES OF THE RECTAL SPHINCTER COMPLEX
DOI:
https://doi.org/10.11603/2414-4533.2026.1.16075Keywords:
gunshot injuries, sphincter complex, rectum, colostomy, sphincteroplasty, combat traumaAbstract
The aim of the work: to systematize and optimize modern approaches to the diagnosis and treatment of gunshot wounds of the rectal sphincter apparatus, taking into account modern principles of damage control surgery and the basics of reconstructive surgery, and to develop a clinical algorithm for managing patient data.
Materials and Methods. An analysis of modern literature sources and a generalization of clinical approaches to the management of patients with gunshot wounds of the anorectal area were conducted. The algorithm included clinical examination, computed tomography of the abdominal cavity and pelvic organs with contrast, sigmoidoscopy, video sigmoidoscopy, intraoperative revision, and endoanal ultrasonography at the reconstruction stage. 26 cases of combat gunshot shrapnel and bullet wounds of the sphincter apparatus of the rectum at the stages of medical evacuation were analyzed.
Results. A differentiated, comprehensive, staged approach depending on the general hemodynamic status of the injured person, the anatomical localization of the injury (intra- or extraperitoneal injuries) and the degree of destruction of the rectal sphincter apparatus allows reducing the frequency of septic complications and improving subsequent functional outcomes. Early fecal diversion (colostomy) with subsequent sphincteroplasty after stabilization of the patient's general condition and normalization of hemodynamic parameters, reduced the frequency of complications and improved subsequent functional outcomes.
Conclusions. Gunshot injuries to the rectal sphincter require differentiated, complex, staged surgical treatment. Early colostomy, primary surgical treatment, and repeated surgical treatment of gunshot wounds with subsequent reconstruction of the rectal sphincter provide optimal control of infection and subsequent restoration of intestinal continence caused by muscle and nerve damage.
Received: 19.01.2026 | Revised: 04.02.2026 | Accepted: 19.02.2026
References
Steele SR, Maykel JA. Management of complex anorectal disease. Clin Colon Rectal Surg. 2018; 31(2):85-92.
Navsaria PH. Damage control surgery in abdominal trauma. World J Surg. 2011; 35(1):147-51.
Demetriades D. Total management of the open abdomen. Br J Surg. 2014; 101(1):e1-e9.
Coccolini F, Roberts D, Ansaloni L, et al. The open abdomen in trauma and non-trauma patients: WSES guidelines. World J Emerg Surg. 2020; 15:32.
Glasgow SC, Steele SR. Operative management of diverticulitis. Clin Colon Rectal Surg. 2017; 30(1):58-66.
Ivatury RR, et al. Damage control surgery and abdominal compartment syndrome. Surg Clin North Am. 2017; 97(5):1105-120.
Rakinic J, et al. Colon trauma management. Surg Clin North Am. 2010; 90(1):137-47.
Burch JM. Management of destructive colon injuries. Adv Surg. 2016; 50:173-85.
Fry RD. Colon and rectum. In: Townsend CM Jr, Beauchamp RD, Evers BM, Mattox KL, editors. Shackelford’s Surgery of the Alimentary Tract. 8th ed. Philadelphia: Elsevier; 2019.
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