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

What is the best practice for injuries greater than 50% to the rectum in the case of extraperitoneal trauma?

1. Primary repair without diversion

2. Direct suture repair

3. Low anterior resection with loop ostomy

4. Abdominoperineal resection

The correct answer is: Low anterior resection with loop ostomy

Injuries to the rectum that are greater than 50% involve significant damage and carry a high risk of complications such as wound infection, anastomotic leakage, and pelvic abscess formation. In the context of extraperitoneal trauma, the best practice is to perform a low anterior resection along with a loop ostomy. This approach allows for the resection of the damaged rectum, maintaining the functional integrity of the remaining bowel while diverting fecal content away from the anastomosis. Creating a loop ostomy helps to protect the surgical site and minimizes the risk of complications, particularly in cases where the blood supply may be compromised due to the injury. The other options do not adequately address the severity of the injury. Primary repair without diversion may expose the patient to high rates of leakage and infection due to the extent of the injury. Direct suture repair is similarly insufficient for managing extensive tissue loss. An abdominoperineal resection is a more radical approach and is typically reserved for cases involving malignancy or when the anal sphincter complex is affected, rather than for trauma repair. Therefore, the combination of low anterior resection with a loop ostomy is the most appropriate and safest choice in managing significant