Simplified management of low-energy projectile extraperitoneal rectal injuries.

Introduction: Since minimally invasive approach for fecal diversion in low-velocity extraperitoneal rectal injuries (EPRI) has a lower morbidity than open, and since computed tomography (CT) scan is helpful in ruling out concomitant intraperitoneal injuries (IPI), we utilized both modalities to simplify management of such injuries.

Methods: Retrospective review of stable patients with EPRI, treated with laparoscopic assisted diversion, after a CT scan, compared with patients with similar injuries that had a negative laparotomy and a colostomy.

Results: The laparoscopy group had a shorter length of stay (3 +/- 2 days versus 7 +/- 2 days), earlier return of bowel function (3 +/- 2 days versus 5 +/- 2 days) and fewer infectious complications.

Screening laboratory and radiology panels for trauma patients have low utility and are not cost effective.

Background: Routine laboratory and radiology panels as part of the initial evaluation of the trauma patient are prevalent practices. This is a study of utility and cost effectiveness of this practice.

Methods: During a 3-month period, trauma panels were analyzed for cost and impact on patient care in our institution.