The value of distal rectal washout in civilian injuries has been questioned. Present-day experience with low-velocity gunshot wounds tends to show no benefit from distal rectal washout, and it is considered to be associated with a high risk of infection because of spillage from the unrepaired extraperitoneal rectal perforation. This has resulted in most trauma surgeons abandoning this procedure.

The placement of a drain in the presacral space through an incision in the anococcygeal raphe was advocated in the military experience, but the only randomised clinical trial in the civilian setting has shown that this did not reduce septic complications and is currently not recommended.

Broad-spectrum antibiotics should be administered for a full period of seven days in the event of an extraperitoneal injury that has been purely managed with a loop colostomy and no laparotomy, and the patient should be monitored closely for the development of pelvic sepsis. If this does occur, then the collection is usually amenable to percutaneous drainage under ultrasound guidance.