EM@3AM: Rectal Injuries

A 27-year-old male presents with multiple gunshot wounds to the lower abdomen. Initial vital signs are BP of 130/80, HR of 110, RR 18, SpO2 of 97% on RA, T 98.5°F. He has 1 penetrating injury to the left lower quadrant of the abdomen and 1 to the right proximal thigh. There is 1 penetrating injury to the right flank and 1 to the right buttocks. Notably, he has gross hematochezia. CT imaging notable for a wound tract adjacent to the patient’s rectum with extraluminal free air.