Journal of Pediatric Surgery Open · Published 2026-07-15 · DOI 10.1016/j.yjpso.2026.100295
María Zornoza, Katherine González, Alejandro Ruíz, Luis de la Torre
Introduction: Penetrating rectal trauma in pediatric patients is rare. Insufficient knowledge of surgical management can result in serious complications. Injury mechanisms and severity differ by case. Current treatment guidelines are based on adult protocols. Methods: We conducted a retrospective case series study of patients with severe penetrating rectal trauma treated at the Centro Colorrectal para Niños between 2015 and 2023. We analyzed demographic data, trauma mechanisms, injury location, involvement of other organs, surgical procedures performed, and postoperative outcomes. Results: We present a case series of 7 patients with a mean age of 13 years. The mechanism of injury included a sharp object, a sharp-cutting object, impalement, and sexual abuse. In four patients, the rectal trauma extended intraperitoneally, with two involving bladder injuries. The other three had an extraperitoneal extension, including a vaginal injury. We treated five primary cases at our hospital, with the 4D protocol that included bowel Diversion, Distal segment irrigation, presacral Drainage, and Debridement to heal the injury. Two cases were referred after being treated with a different approach. These two patients developed complications and increased morbidity Discussion: In this small case series, application of a structured management strategy incorporating the principles of the 4D protocol was associated with favorable clinical and functional outcomes in pediatric patients with severe penetrating rectal trauma. Conclusions: Based on this limited experience, the 4D protocol appears to be a safe and practical framework for the management of severe penetrating rectal trauma in children. Larger studies are needed to define its role in pediatric practice. Level of evidence: III
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Zornoza, M., González, K., Ruíz, A., et al. (2026). Successful experience in the acute management of penetrating rectal trauma in children using the 4D protocol. Journal of Pediatric Surgery Open. https://doi.org/10.1016/j.yjpso.2026.100295