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Rectal trauma is uncommon, but it is usually associated with injuries in adjacent pelvic or abdominal organs. Recent studies have changed the paradigm behind military rectal trauma management, showing better morbidity and mortality. However, damage control techniques in rectal trauma remain controversial. This article aims to present an algorithm for the treatment of rectal trauma in a patient with hemodynamic instability, according to damage control surgery principles. We propose to manage intraperitoneal rectal injuries in the same way as colon injuries. The treatment of extraperitoneal rectum injuries will depend on the percentage of the circumference involved. For injuries involving more than 25% of the circumference, a colostomy is indicated. While injuries involving less than 25% of the circumference can be managed through a conservative approach or primary repair. In rectal trauma, knowing when to do or not to do it makes the difference.

Luis Saldarriaga, Division of Trauma and Acute Care Surgery, Department of Surgery. Universidad del Valle, Cali, Colombia. Division of Trauma and Acute Care Surgery, Department of Surgery. Hospital Universitario del Valle, Cali, Colombia.

orcid_id14.png https://orcid.org/0000-0002-7955-8466

Helmer Emilio Palacios-Rodríguez, Division of Trauma and Acute Care Surgery, Department of Surgery. Universidad del Valle, Cali, Colombia

orcid_id14.png https://orcid.org/0000-0002-6684-982X

Luis Fernando Pino, Division of Trauma and Acute Care Surgery, Department of Surgery. Universidad del Valle, Cali, Colombia. Division of Trauma and Acute Care Surgery, Department of Surgery. Hospital Universitario del Valle, Cali, Colombia.

orcid_id14.png https://orcid.org/0000-0002-1179-2854

Adolfo González-Hadad, Division of Trauma and Acute Care Surgery, Department of Surgery. Universidad del Valle, Cali, Colombia. Division of Trauma and Acute Care Surgery, Department of Surgery. Hospital Universitario del Valle, Cali, Colombia. Centro Médico Imbanaco, Cali, Colombia

orcid_id14.png https://orcid.org/0000-0001-5862-4906

Linda M. Gallego, Universidad Icesi, Cali, Colombia.

orcid_id14.png https://orcid.org/0000-0001-9081-5016

Jessica Capre, Division of Colorectal Surgery, Department of Surgery, Fundacion Valle del Lili, Cali, Colombia

orcid_id14.png https://orcid.org/0000-0002-1577-5525

Alberto García, Division of Trauma and Acute Care Surgery, Department of Surgery. Universidad del Valle, Cali, Colombia. Division of Trauma and Acute Care Surgery, Department of Surgery. Fundación Valle del Lili. Cali, Colombia. Universidad Icesi, Cali, Colombia.

orcid_id14.png https://orcid.org/0000-0002-4096-1434

Fernando Rodriguez-Holguín, Division of Trauma and Acute Care Surgery, Department of Surgery. Fundación Valle del Lili. Cali, Colombia

orcid_id14.png https://orcid.org/0000-0002-5326-2317

Alexander Salcedo, Division of Trauma and Acute Care Surgery, Department of Surgery. Universidad del Valle, Cali, Colombia. Centro Médico Imbanaco, Cali, Colombia. Division of Trauma and Acute Care Surgery, Department of Surgery. Fundación Valle del Lili. Cali, Colombia. Universidad Icesi, Cali, Colombia

orcid_id14.png https://orcid.org/0000-0001-8187-0638

Jose Julian Serna, Division of Trauma and Acute Care Surgery, Department of Surgery. Universidad del Valle, Cali, Colombia. Centro Médico Imbanaco, Cali, Colombia. Division of Trauma and Acute Care Surgery, Department of Surgery. Fundación Valle del Lili. Cali, Colombia. Universidad Icesi, Cali, Colombia

orcid_id14.png https://orcid.org/0000-0001-9829-8930

Mario Alain Herrera, Division of Trauma and Acute Care Surgery, Department of Surgery. Universidad del Valle, Cali, Colombia. Division of Trauma and Acute Care Surgery, Department of Surgery. Hospital Universitario del Valle, Cali, Colombia.

orcid_id14.png https://orcid.org/0000-0002-4526-7636

Michael Parra, Department of Trauma Critical Care, Broward General Level I Trauma Center, Fort Lauderdale, FL – USA

orcid_id14.png https://orcid.org/0000-0001-6496-6275

Carlos Alberto Ordoñez, Division of Trauma and Acute Care Surgery, Department of Surgery. Universidad del Valle, Cali, Colombia. Division of Trauma and Acute Care Surgery, Department of Surgery. Fundación Valle del Lili. Cali, Colombia. Universidad Icesi, Cali, Colombia.

orcid_id14.png https://orcid.org/0000-0003-4495-7405

Abraham Kestenberg-Himelfarb, Division of Colorectal Surgery, Department of Surgery, Fundacion Valle del Lili, Cali, Colombia

orcid_id14.png https://orcid.org/0000-0002-6163-4651

Saldarriaga, L., Palacios-Rodríguez, H. E., Pino, L. F., González-Hadad, A., Gallego, L. M., Capre, J., García, A., Rodriguez-Holguín, F., Salcedo, A., Serna, J. J., Herrera, M. A., Parra, M., Ordoñez, C. A., & Kestenberg-Himelfarb, A. (2024). Rectal damage control: when to do and not to do. Colombia Medica, 52(2), e4124776. https://doi.org/10.25100/cm.v52i2.4776 (Original work published June 8, 2021)

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