EP602 - Beyond Stomas: Use of Transanal Minimally Invasive Surgery (TAMIS) and Conservative Treatment in Extraperitoneal Rectal Trauma, a Case Series.

Monday, May 12, 2025

8:16 AM – 8:21 AM PT

Location: Monitor 1, Sails Pavilion, Upper Level

ePoster Presenter(s)

JC

Jessica Capre-Pereira, MD

Colorectal surgeon
Fundacion Valle del Lili, Cali, Colombia. Universidad ICESI, Cali, Colombia.
Cali, Valle del Cauca, Colombia

All of the relevant financial relationships listed below have been mitigated.
This individual has no financial relationships with ineligible companies.

Author(s)

AK

Abraham Kestenberg, MD

Colorectal Surgeon, Director of the Department of Coloproctology and Academic Director of Fellow in
Fundacion Valle del Lili, Cali, Colombia. Profesor in Universidad ICESI, Cali, Colombia
Cali, Valle del Cauca, Colombia

All of the relevant financial relationships listed below have been mitigated.
This individual has no financial relationships with ineligible companies.
JH

Juan-Guillermo Holguin, MD

Colorectal surgeon
Fundacion Valle del Lili, Cali, Colombia. Universidad ICESI, Cali, Colombia.
Cali, Valle del Cauca, Colombia

Disclosure information not submitted.
AO

Alexander Obando, MD

Colorectal surgeon
Fundacion Valle del Lili, Cali, Colombia. Universidad ICESI, Cali, Colombia.
Cali, Valle del Cauca, Colombia

Disclosure information not submitted.
HP

Helber F. Perez, MD

Research Assistant
Centro de Investigaciones Clínicas, Fundacion Valle del Lili, Cali, Colombia. Universidad ICESI, Master's student in Epidemiology Universidad Libre, Chapter of Future Surgeons, Colombian Association of Surgery.
CALI, Valle del Cauca, Colombia

Disclosure information not submitted.
SG

Sandra Gutierrez, MD FACS

Colorectal Surgery Fellow
Facultad de Ciencias de la Salud, Universidad ICESI
Cali, Valle del Cauca, Colombia

Disclosure information not submitted.
KP

Karen Ponce, MD FACS

Colorectal Surgery Fellow
Facultad de Ciencias de la Salud, Universidad ICESI
Cali, Valle del Cauca, Colombia

Disclosure information not submitted.
CA

Cristhian Arroyave, MD

Colorectal Surgery Fellow
Facultad de Ciencias de la Salud, Universidad ICESI
Cali, Valle del Cauca, Colombia

Disclosure information not submitted.
DL

Diana-Marcela Lopez, n/a

Undergraduate Medical Student
Facultad de Ciencias de la Salud, Universidad ICESI
Cali, Valle del Cauca, Colombia

Disclosure information not submitted.
AG

Alberto F. Garcia, MD MSc

Trauma and Acute Care Surgeon
Fundacion Valle del Lili, Cali, Colombia. Universidad ICESI, Cali, Colombia.
Cali, Valle del Cauca, Colombia

Disclosure information not submitted.

Senior Author(s)

CO

Carlos Ordoñez, MD FACS

Chief of Trauma and Emergency Surgery, Fundación Valle del Lili
Fundacion Valle del Lili, Cali, Colombia. Universidad ICESI, Cali, Colombia.
Cali, Valle del Cauca, Colombia

All of the relevant financial relationships listed below have been mitigated.
This individual has no financial relationships with ineligible companies.

All of the relevant financial relationships listed below have been mitigated.

Jessica Capre-Pereira, MD: This individual has no financial relationships with ineligible companies.

Abraham Kestenberg, MD: This individual has no financial relationships with ineligible companies.

Carlos Ordoñez, MD FACS: This individual has no financial relationships with ineligible companies.

Image or Table (Do Not add text here):

Purpose/Background: Rectal trauma is rare (0.1% to 0.5%) and is usually caused by penetrating injuries (71-85% of cases). Historically, treatment has been based on military stoma creation, used in up to 73% of cases, but associated with high morbidity and mortality. Transanal minimally invasive surgery (TAMIS), although initially for benign tumors, offers a safe alternative for extraperitoneal rectal lesions where primary repair is feasible with lower risk. For certain small lesions, nonsurgical management with close surveillance may be feasible. Our institution's protocol uses TAMIS and conservative management based on compromise of rectal circumference, associated injuries and time of trauma evolution to avoid routine use of ostomies. This study describes three cases: two treated with TAMIS and one treated conservatively, all with good results and without the need for an ostomy.

Methods/Interventions: Case series. In early 2024, an institutional protocol for the management of extraperitoneal rectal trauma was implemented, focusing on the involvement of the rectal circumference (> or < 25%) and the time of evolution of the trauma. The three cases were attended in a high complexity trauma center, were managed according to the institutional protocol established for the initial approach to trauma under the ATLS guidelines, with immediate evaluation by the emergency medicine, trauma and emergency surgery and coloproctology teams, and laboratory investigations, assessment of trajectories and associated lesions by means of high-resolution tomography type images with trauma protocol, referral to other specialties according to clinical and tomographic findings and at the appropriate time for each case the performance of flexible sigmoidoscopy to determine the percentage of involvement of the rectal lumen. Once determined in relation to the time of evolution of the trauma, surgical treatment was performed with TAMIS (Figure 1) or conservative treatment with close clinical follow-up. All patients were followed for 30 days after discharge with flexible sigmoidoscopy.

Results/Outcomes: Case 1: A 19-year-old male with a transpelvic gunshot injury (TGPI) to the middle and lower rectum underwent TAMIS with primary closure. He developed a presacral collection requiring percutaneous drainage and was discharged after antibiotics. Case 2: A 19-year-old male with TGPI and a 6 cm extraperitoneal rectal wound underwent TAMIS with primary closure and was discharged 7 days later without complications (Figure 2). Case 3: A 25-year-old male with a right thoracoabdominal gunshot wound (TAGW) and TGPI had a rectal trauma 5 cm from the anal flange. He was treated conservatively and discharged 10 days later without complications. Two patients presented with associated fractures and one patient presented with vascular trauma. These lesions did not require surgical intervention. No new symptoms or complications were reported at follow-up.

Conclusion/Discussion: Rectal trauma, although rare, is associated with significant mortality and morbidity. Management depends on the mechanism of trauma, hemodynamic status, time to diagnosis, severity of injury, associated injuries, and difficulty of approach, particularly in the extraperitoneal rectum. Conservative management and TAMIS may be an alternative for a less invasive approach to extraperitoneal rectal trauma, with the advantage of a minimally invasive approach and no entry into the peritoneal cavity; in addition, it avoids the use of stomas or placement of drainage systems.