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

Which technique is preferred for management of rectal injuries that are classified as less than 50%?

1. End-ostomy

2. Primary repair without diversion

3. Diverting colostomy

4. Immediate laparotomy

The correct answer is: Primary repair without diversion

In the management of rectal injuries that are classified as less than 50%, the preferred technique is to perform a primary repair without diversion. This approach is favored because it allows for the direct repair of the rectal tissue, promoting healing and minimizing the potential complications associated with long-term diversion strategies. Primary repair without diversion is indicated for less severe injuries where there is sufficient vascularity and no significant contamination or associated injuries. By opting for this method, the goal is to preserve bowel continuity, which is beneficial for the patient's overall gastrointestinal function and recovery. It avoids the complications that can arise from creating a stoma, such as those related to skin integrity, stoma management, or psychological impacts on patients. In contrast, techniques such as end-ostomy or diverting colostomy are typically reserved for more significant injuries or those with more extensive damage, as they may require bowel diversion to protect the repair when there is a high risk of contamination or complications from the injury. Immediate laparotomy is a surgical intervention that may be necessary for more complex cases or if there are other life-threatening injuries, but it is not specifically a technique for rectal repair alone unless indicated by the injury's extent. Thus, primary repair without diversion is the optimal choice for less