Chapter 94- Part C: Rectal Tears, Dehiscence, and the Suture Lie

In this BoardsCast episode, we continue Tobias Chapter 94 — Rectum, Anus, and Perineum by confronting the most dangerous belief in rectal repair:

“If the sutures hold, the repair holds.”

That’s the suture lie.

Rectal failures are usually not knot failures — they’re biology failures inside a rigid pelvic cage, where three forces decide whether the patient survives:

contamination + tension + perfusion.

This episode builds the board-level failure framework for why rectal repairs can look stable in the OR, then dehisce in the post-op day 3–5 window when tissue strength drops, swelling peaks, and tenesmus turns a “tension-free” repair into a strangled one.

You’ll learn:

• Why rectal tears are inoculation events (anaerobes + contamination drive rapid failure)
• Why pelvic anatomy creates hidden tension after anesthesia wears off (tone + edema + straining)
• Why “pink” is a trap: perfusion can be compromised even when tissue looks viable
• The predictable dehiscence timeline: microleak → inflammation → edema → perfusion loss → necrosis
• The board pattern: day 3–5 decline = septic dehiscence until proven otherwise
• Prevention priorities that actually move outcomes: source control, true tension-free repair, protect blood supply, and aggressive post-op straining control

If you remember one line: sutures don’t save ischemic tissue. Biology wins.

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