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

Which approach is advised for low extraperitoneal rectal trauma?

1. Transanal repair

2. End ostomy

3. Laparotomy

4. Loop ostomy

The correct answer is: Transanal repair

The advised approach for low extraperitoneal rectal trauma is transanal repair because this technique enables direct access to the affected area with minimal disruption to surrounding tissues. When dealing with low-lying rectal injuries that do not involve extensive damage or the need for diversion, a transanal approach allows for effective control of the injury and repair while preserving rectal function as much as possible. In low extraperitoneal injuries, where the insult primarily affects the rectal wall itself, the goal is to repair the injury and manage any potential contamination that can occur due to fecal material. By opting for a transanal repair, the surgeon can effectively suture the damaged rectal tissue, facilitating healing while potentially avoiding the need for more invasive procedures that could impose additional risks or complications. This approach stands in contrast to methods such as end ostomy or loop ostomy, which are generally utilized in cases of more significant injury or when diversion is necessary due to extensive damage, contamination, or instability. Laparotomy, a more extensive surgical procedure, is reserved for cases involving intra-abdominal trauma or severe hemorrhage that require broader access and intervention. Therefore, transanal repair is the most suitable method for low extraperitoneal rectal trauma, emphasizing