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Minimally invasive approach to low-velocity penetrating extraperitoneal rectal trauma
  1. Megan Melland-Smith1,
  2. Tyler R Chesney1,
  3. Shady Ashamalla1,2,
  4. Fred Brenneman1,2
  1. 1General Surgery, University of Toronto, Toronto, Ontario, Canada
  2. 2Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
  1. Correspondence to Dr Megan Melland-Smith, General Surgery, University of Toronto, Toronto, ON M5S, Canada; megan.melland-smith{at}


Unlike intraperitoneal colorectal injuries, the standard of care for extraperitoneal rectal trauma includes a diverting colostomy due to relative inaccessibility of these injuries for primary repair. New technologies to enhance access to the extraperitoneal rectum have gained increasing use in benign and malignant rectal disease. We present two cases of low-velocity penetrating extraperitoneal rectal trauma. In both cases, a transanal minimally invasive surgery (TAMIS) approach was used to access, and primarily repair, full-thickness rectal lacerations. These patients were successfully managed without a colostomy and without complication. TAMIS enables access to distal rectal injuries, facilitating primary repair and bringing the management of extraperitoneal rectal injuries in line with intraperitoneal injuries, with the potential to avoid fecal diversion.

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  • Contributors All authors have satisfied the ICMJE criteria for authorship.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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