{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,6]],"date-time":"2026-06-06T01:31:34Z","timestamp":1780709494198,"version":"3.54.1"},"reference-count":21,"publisher":"BMJ","issue":"1","license":[{"start":{"date-parts":[[2026,1,29]],"date-time":"2026-01-29T00:00:00Z","timestamp":1769644800000},"content-version":"unspecified","delay-in-days":28,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Trauma Surg Acute Care Open"],"accepted":{"date-parts":[[2026,1,14]]},"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Retroperitoneal rectal injuries (RRIs) caused by combined military trauma represent a complex clinical challenge, especially in modern armed conflicts. Traditional management protocols have evolved significantly since World War II, emphasizing fecal diversion and presacral drainage. However, emerging evidence supports primary repair as a viable alternative for select cases. This study evaluates the efficacy of primary repair for RRIs among military trauma patients treated at a tertiary center.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A retrospective cohort study was conducted at the National Cancer Institute, Kyiv, Ukraine, from February 2022 to March 2024. Patients with RRIs due to combined military trauma were analyzed, excluding isolated or intraperitoneal rectal injuries. Surgical interventions included primary repair, loop sigmoidostomy, presacral drainage, and rectal washout. Postoperative outcomes were assessed, including complication rates, hospital length of stay (LOS), and mortality. Statistical analyses included \u03c72, Fisher\u2019s exact, t-tests, and logistic regression, with p&lt;0.05 considered significant.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Twelve patients met the inclusion criteria, with a median age of 33 years (IQR 27\u201340). Seven patients underwent primary repair, achieving an 85.7% success rate (\u03c72=10.89, p=0.001). Patients receiving primary repair experienced significantly shorter LOS (55 days, IQR 44\u201364 140 days, IQR 99\u2013141, p=0.048) and lower complication rates (28.5% vs 80%, p=0.079). No mortality was reported. Loop sigmoidostomy showed a 66.6% success rate, while presacral drainage and rectal washout yielded limited efficacy, particularly in severe injuries.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Primary repair may represent a viable and promising option for managing RRIs in selected patients with combined military trauma, potentially reducing LOS and postoperative complications compared to more invasive approaches. Nevertheless, given the limited sample size (n=12), these findings should be regarded as exploratory, underscoring the need for larger, prospective studies to confirm their validity.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Level of evidence<\/jats:title>\n                    <jats:p>III-2 A comparative study with concurrent controls.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/tsaco-2024-001720","type":"journal-article","created":{"date-parts":[[2026,1,29]],"date-time":"2026-01-29T14:40:15Z","timestamp":1769697615000},"page":"e001720","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":2,"title":["Efficacy of primary repair for retroperitoneal rectal injuries among patients with combined military trauma: tertiary single-center experience"],"prefix":"10.1136","volume":"11","author":[{"given":"Yurii","family":"Kondratskyi","sequence":"first","affiliation":[{"name":"Surgical Oncology Clinic, National Cancer Institute, Kyiv, Ukraine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anatolii","family":"Shudrak","sequence":"additional","affiliation":[{"name":"National Cancer Institute, Kyiv, Ukraine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andriy","family":"Beznosenko","sequence":"additional","affiliation":[{"name":"National Cancer Institute, Kyiv, Ukraine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yaroslav","family":"Zarutskyi","sequence":"additional","affiliation":[{"name":"Ukrainian Military Medical Academy, Kyiv, Kyiv City, Ukraine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-7902-9809","authenticated-orcid":false,"given":"Andrii","family":"Horodetskyi","sequence":"additional","affiliation":[{"name":"National Cancer Institute, Kyiv, Ukraine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mykyta","family":"Pepenin","sequence":"additional","affiliation":[{"name":"National Cancer Institute, Kyiv, Ukraine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Oleksii","family":"Dobrzhanskyi","sequence":"additional","affiliation":[{"name":"National Cancer Institute, Kyiv, Ukraine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Valerii","family":"Turchak","sequence":"additional","affiliation":[{"name":"National Cancer Institute, Kyiv, Ukraine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yevhenii","family":"Shudrak","sequence":"additional","affiliation":[{"name":"National Cancer Institute, Kyiv, Ukraine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrii","family":"Kolesnyk","sequence":"additional","affiliation":[{"name":"National Cancer Institute, Kyiv, Ukraine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nataliia","family":"Koval","sequence":"additional","affiliation":[{"name":"National Cancer Institute, Kyiv, Ukraine"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,1,29]]},"reference":[{"key":"2026012906400605000_11.1.e001720.1","unstructured":"Long DM , Buchalter S , Murray CK . Trauma care in austere environments. In: Combat Casualty Care: Lessons Learned from OEF and OIF. 2020."},{"key":"2026012906400605000_11.1.e001720.2","doi-asserted-by":"crossref","first-page":"555","DOI":"10.1016\/S0140-6736(00)74760-X","article-title":"Forward surgery of abdominal wounds*1","volume":"243","author":"Ogilvie","year":"1944","journal-title":"The Lancet"},{"key":"2026012906400605000_11.1.e001720.3","doi-asserted-by":"publisher","DOI":"10.1016\/0002-9610(71)90322-9"},{"key":"2026012906400605000_11.1.e001720.4","doi-asserted-by":"publisher","DOI":"10.1097\/00000658-197910000-00002"},{"key":"2026012906400605000_11.1.e001720.5","doi-asserted-by":"crossref","first-page":"656","DOI":"10.1097\/00005373-199810000-00002","article-title":"The Role of Presacral Drainage in the Management of Penetrating Rectal Injuries","volume":"45","author":"Gonzalez","year":"1998","journal-title":"The Journal of Trauma: Injury, Infection, and Critical Care"},{"key":"2026012906400605000_11.1.e001720.6","doi-asserted-by":"crossref","first-page":"363","DOI":"10.1097\/01.SLA.0000055222.90581.59","article-title":"Colon and rectal surgery without mechanical bowel preparation: A randomized prospective trial","volume":"237","author":"Zmora","year":"2009","journal-title":"Ann Surg"},{"key":"2026012906400605000_11.1.e001720.7","first-page":"765","article-title":"Committee on Multicenter Clinical Trials","volume":"50","author":"Demetriades","year":"2001","journal-title":"American Association for the Surgery of Trauma, Journal of Trauma"},{"key":"2026012906400605000_11.1.e001720.8","doi-asserted-by":"crossref","first-page":"100024","DOI":"10.1016\/j.sipas.2020.100024","article-title":"Contemporary diagnosis and management of traumatic rectal injuries","volume":"4","author":"Emigh","year":"2021","journal-title":"Surgery in Practice and Science"},{"key":"2026012906400605000_11.1.e001720.9","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1016\/S1015-9584(09)60286-4","article-title":"Management of civilian extraperitoneal rectal injuries","volume":"29","author":"Shatnawi","year":"2006","journal-title":"Asian J Surg"},{"key":"2026012906400605000_11.1.e001720.10","first-page":"620","article-title":"Management of destructive wounds of the colon: The impact of primary repair and diversion","volume":"168","author":"Stewart","year":"1994","journal-title":"Am J Surg"},{"key":"2026012906400605000_11.1.e001720.11","first-page":"570","article-title":"Combat wounds of the extraperitoneal rectum","volume":"74","author":"Armstrong","year":"1973","journal-title":"Surgery"},{"key":"2026012906400605000_11.1.e001720.12","doi-asserted-by":"crossref","first-page":"989","DOI":"10.1097\/00005373-198807000-00013","article-title":"Value of distal colon washout in civilian rectal trauma--reducing gut bacterial translocation","volume":"28","author":"Shannon","year":"1988","journal-title":"J Trauma"},{"key":"2026012906400605000_11.1.e001720.13","doi-asserted-by":"crossref","DOI":"10.1016\/j.tcr.2021.100554","article-title":"Extraperitoneal rectal trauma in a patient with multiple gunshot wounds: A case report and literature review","volume":"36","author":"McFadgen","year":"2021","journal-title":"Trauma Case Rep"},{"key":"2026012906400605000_11.1.e001720.14","doi-asserted-by":"crossref","first-page":"5","DOI":"10.1055\/s-0037-1602174","article-title":"Historical Perspectives on Colorectal Trauma Management","volume":"31","author":"Tyler","year":"2018","journal-title":"Clin Colon Rectal Surg"},{"key":"2026012906400605000_11.1.e001720.15","doi-asserted-by":"crossref","DOI":"10.1097\/AS9.0000000000000097","article-title":"Laparoscopic Versus Open Colorectal Surgery in the Emergency Setting: A Systematic Review and Meta-analysis","volume":"2","author":"Warps","year":"2021","journal-title":"Ann Surg Open"},{"key":"2026012906400605000_11.1.e001720.16","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjsurg.2012.10.021"},{"key":"2026012906400605000_11.1.e001720.17","doi-asserted-by":"publisher","DOI":"10.1177\/1457496914523414"},{"key":"2026012906400605000_11.1.e001720.18","unstructured":"American Association for the Surgery of Trauma . Organ injury scaling: colon and rectum. Available: https:\/\/www.aast.org\/trauma-scoring\/colon-and-rectum-injury-scale [Accessed 23 Nov 2024]."},{"key":"2026012906400605000_11.1.e001720.19","doi-asserted-by":"publisher","DOI":"10.1097\/00005373-197403000-00001"},{"key":"2026012906400605000_11.1.e001720.20","unstructured":"Feliciano DV , Kenny PJ , Moore EE . Colon and rectum. 9th edn. McGraw-Hill Education, 2021: 737\u201343."},{"key":"2026012906400605000_11.1.e001720.21","doi-asserted-by":"crossref","first-page":"546","DOI":"10.1097\/TA.0000000000000953","article-title":"Management of penetrating extraperitoneal rectal injuries: An Eastern Association for the Surgery of Trauma practice management guideline","volume":"80","author":"Bosarge","year":"2016","journal-title":"J Trauma Acute Care Surg"}],"container-title":["Trauma Surgery &amp; Acute Care Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/tsaco-2024-001720","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,1,29]],"date-time":"2026-01-29T14:40:19Z","timestamp":1769697619000},"score":1,"resource":{"primary":{"URL":"https:\/\/tsaco.bmj.com\/lookup\/doi\/10.1136\/tsaco-2024-001720"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,1]]},"references-count":21,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,1,29]]},"published-print":{"date-parts":[[2026,1]]}},"alternative-id":["10.1136\/tsaco-2024-001720"],"URL":"https:\/\/doi.org\/10.1136\/tsaco-2024-001720","relation":{},"ISSN":["2397-5776"],"issn-type":[{"value":"2397-5776","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,1]]}}}