Surgical tactics in gunshot injuries of the rectum

Gunshot rectal injuries, although uncommon, are a source of significant morbidity and mortality. These injuries are associated with a significant potential for life-threatening septic complications if they are not recognized and treated promptly. The gold standard has been intestinal diversion, primary rectal repair, distal rectal washout and presacral drainage. The management of these injuries has evolved, and controversy now exists as to the need for each of these maneuvers. An approach based on mechanism and degree of tissue destruction, location of injury, and associated organ involvement is now advocated.