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

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What surgical intervention is recommended for middle extraperitoneal rectal trauma?

Primary repair without diversion
End-ostomy
Loop colostomy
Low anterior resection

The correct answer is: End-ostomy

For middle extraperitoneal rectal trauma, the recommended surgical intervention is typically to perform an end-ostomy. This approach is often favored in the setting of significant injury to the rectum, particularly when there is a concern for contamination or a high risk of subsequent complications such as fistula formation. In extraperitoneal rectal injuries, the integrity of the rectal wall may be compromised, and if the injury is severe enough, attempting a primary repair without diversion can increase the risk of significant morbidity, including sepsis from fecal contamination. The creation of an end-ostomy diverts the fecal stream away from the injured site, thereby allowing for bowel rest and the potential for healing or further surgical intervention at a later date. This strategy reduces the risk of complications associated with direct repair in cases of unstable or contaminated injuries. Furthermore, it provides a safer initial management of the trauma while allowing the surgical team flexibility as the patient's condition evolves.