Quadrant | Injury | Management |
LI | Extraperitoneal, anterior+posterior rectal injury, >25% circumference. | Diagnostic laparoscopy+defunctioning ileostomy. Reversed 5 months later. |
LI | Extraperitoneal injury at 5 o’clock position, <25% circumference, some division of sphincter. | Rectum sutured+drain inserted. Diagnostic laparoscopy normal. |
LI | Suspected extraperitoneal rectal injury <25% circumference. Intramural blood, blood, and feces obscuring view on RS, large mesorectal hematoma on diagnostic laparoscopy. | Laparoscopic loop colostomy, reversed 3 months later. |
LI | Anal sphincter injury, <25% circumference. | Washout+packing. |
UI | Extraperitoneal injury, 25% of circumference, 6–9 o’clock 8 cm from anal verge. | Laparoscopic loop colostomy. Reversed 6 months later. |
LI | Extraperitoneal, laceration 2 cm from anal verge extending radially to around 4 cm, <25% circumference. External anal sphincter fibers seen. | EUA+packing of rectum+RS+second look EUA. |
EUA, examination under anesthetic; LI, lower inner; RS, rigid sigmoidoscopy; UI, upper inner.