American Board of Surgery Qualifying Exam (ABS QE) Practice Test

What is the management for rectal trauma if shock is present?

1. Primary repair with diversion

2. Immediate exploration

3. End ostomy

4. Observation only

The correct answer is: End ostomy

In the context of managing rectal trauma with associated shock, the most appropriate course of action is to establish an end ostomy. The presence of shock indicates that the patient is likely experiencing significant blood loss or fluid instability, necessitating immediate interventions that prioritize stabilization and contamination control. An end ostomy serves two critical purposes in this situation. First, it allows for bowel diversion, thus preventing fecal contamination of the peritoneal cavity, which could worsen the patient's condition and complicate the trauma surgery. Second, by creating an ostomy, the surgical team can focus on managing the patient's hemodynamic status without the additional stress of repairing the rectum immediately, especially if the nature of the injury is complex or if there's a high likelihood of contamination that could lead to further complications. While other approaches, such as primary repair with diversion or immediate exploration, may be appropriate in select cases of rectal trauma without shock, they could exacerbate the patient's instability due to the inherent risks involved, such as further blood loss or injury to adjacent structures. In the setting of an unstable patient, conservative management like observation only would also be inadequate since it would not address the urgent need for diversion and hemostatic control. Overall, the choice of an end ost