Penetrating Rectal Trauma: Management and Outcomes at a Tertiary Military Hospital in Sana’a, Yemen

Background: Penetrating rectal trauma (PRT) presents a formidable challenge in conflicting settings. This study aimed to evaluate the management and outcomes of PRT at a tertiary military hospital in Yemen. Methods: A retrospective review of 32 patients who underwent PRT was conducted between January 2019 and March 2022. We analyzed the data on patient demographics, injury patterns, management strategies, and clinical outcomes. Results: All patients were male (93.8%) aged < 30 years. The injuries were caused by gunshots (62.6%) or bombs (37.4%). The majority (53.2%) presented > 24 hours post-injury. Most injuries were extraperitoneal (62.5%) and American Association for the Surgery of Trauma (AAST) Grade II (96.9%), with pelvic fractures being the most commonly associated injury (53.1%). Management predominantly involves a diversion colostomy. Complication rates were high, including rectocutaneous fistula (34.1%) and necrotizing fasciitis (31.0%). The overall mortality rate was 6.2%. Among survivors, 31.3% experienced significant morbidity. Conclusion: Delayed presentation is a key driver of the high complication rates observed in PRT within this conflict setting. Although fecal diversion helps to manage mortality, the burden of morbidity remains a significant concern, highlighting the challenges of trauma care in resource-limited environments.