Management of a traumatic anorectal full-thickness laceration: a case report
The rectum is the least frequently injured organ in trauma, with an incidence of about 1% to 3% in trauma cases involving civilians. Most rectal injuries are caused by gunshot wounds, blunt force trauma, and stab wounds. A 46-year-old male patient was crushed between two vehicles while he was workin...
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Korean Society of Traumatology
2022-09-01
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| Series: | Journal of Trauma and Injury |
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| Online Access: | http://jtraumainj.org/upload/pdf/jti-2021-0049.pdf |
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| author | Laura Fortuna Andrea Bottari Riccardo Somigli Sandro Giannessi |
| author_facet | Laura Fortuna Andrea Bottari Riccardo Somigli Sandro Giannessi |
| author_sort | Laura Fortuna |
| collection | DOAJ |
| description | The rectum is the least frequently injured organ in trauma, with an incidence of about 1% to 3% in trauma cases involving civilians. Most rectal injuries are caused by gunshot wounds, blunt force trauma, and stab wounds. A 46-year-old male patient was crushed between two vehicles while he was working. He was hemodynamically unstable, and the Focused Assessment with Sonography for Trauma showed hemoperitoneum and hemoretroperitoneum; therefore, damage control surgery with pelvic packing was performed. A subsequent whole-body computed tomography scan showed a displaced pelvic bone and sacrum fracture. There was evidence of an anorectal full-thickness laceration and urethral laceration. In second-look surgery performed 48 hours later, the pelvis was stabilized with external fixators, and it was decided to proceed with loop sigmoid colostomy. A tractioned rectal probe with an internal balloon was positioned in order to approach the flaps of the rectal wall laceration. On postoperative day 13, a radiological examination with endoluminal contrast injected from the stoma after removal of the balloon was performed and showed no evidence of extraluminal leak. Rectosigmoidoscopy, rectal manometry, anal sphincter electromyography, and trans-stomic transit examinations showed normal findings, indicating that it was appropriate to proceed with the closure of the colostomy. The postoperative course was uneventful. The optimal management for extraperitoneal penetrating rectal injuries continues to evolve. Primary repair with fecal diversion is the mainstay of treatment, and a conservative approach to rectal lacerations with an internal balloon in a rectal probe could provide a possibility for healing with a lower risk of complications. |
| format | Article |
| id | doaj-art-f7cfaa0637424f93ab0a84df460c4987 |
| institution | Kabale University |
| issn | 2799-4317 2287-1683 |
| language | English |
| publishDate | 2022-09-01 |
| publisher | Korean Society of Traumatology |
| record_format | Article |
| series | Journal of Trauma and Injury |
| spelling | doaj-art-f7cfaa0637424f93ab0a84df460c49872025-01-16T04:54:41ZengKorean Society of TraumatologyJournal of Trauma and Injury2799-43172287-16832022-09-0135321521810.20408/jti.2021.00491123Management of a traumatic anorectal full-thickness laceration: a case reportLaura Fortuna0Andrea Bottari1Riccardo Somigli2Sandro Giannessi3 Department of General Surgery, AOU Careggi University Hospital, Florence, Italy Department of General Surgery, AOU Careggi University Hospital, Florence, Italy Department of General Surgery, San Jacopo Hospital, Pistoia, Italy Department of General Surgery, San Jacopo Hospital, Pistoia, ItalyThe rectum is the least frequently injured organ in trauma, with an incidence of about 1% to 3% in trauma cases involving civilians. Most rectal injuries are caused by gunshot wounds, blunt force trauma, and stab wounds. A 46-year-old male patient was crushed between two vehicles while he was working. He was hemodynamically unstable, and the Focused Assessment with Sonography for Trauma showed hemoperitoneum and hemoretroperitoneum; therefore, damage control surgery with pelvic packing was performed. A subsequent whole-body computed tomography scan showed a displaced pelvic bone and sacrum fracture. There was evidence of an anorectal full-thickness laceration and urethral laceration. In second-look surgery performed 48 hours later, the pelvis was stabilized with external fixators, and it was decided to proceed with loop sigmoid colostomy. A tractioned rectal probe with an internal balloon was positioned in order to approach the flaps of the rectal wall laceration. On postoperative day 13, a radiological examination with endoluminal contrast injected from the stoma after removal of the balloon was performed and showed no evidence of extraluminal leak. Rectosigmoidoscopy, rectal manometry, anal sphincter electromyography, and trans-stomic transit examinations showed normal findings, indicating that it was appropriate to proceed with the closure of the colostomy. The postoperative course was uneventful. The optimal management for extraperitoneal penetrating rectal injuries continues to evolve. Primary repair with fecal diversion is the mainstay of treatment, and a conservative approach to rectal lacerations with an internal balloon in a rectal probe could provide a possibility for healing with a lower risk of complications.http://jtraumainj.org/upload/pdf/jti-2021-0049.pdfemergency surgeryrectal traumahip fracturescrush injuriescase reports |
| spellingShingle | Laura Fortuna Andrea Bottari Riccardo Somigli Sandro Giannessi Management of a traumatic anorectal full-thickness laceration: a case report Journal of Trauma and Injury emergency surgery rectal trauma hip fractures crush injuries case reports |
| title | Management of a traumatic anorectal full-thickness laceration: a case report |
| title_full | Management of a traumatic anorectal full-thickness laceration: a case report |
| title_fullStr | Management of a traumatic anorectal full-thickness laceration: a case report |
| title_full_unstemmed | Management of a traumatic anorectal full-thickness laceration: a case report |
| title_short | Management of a traumatic anorectal full-thickness laceration: a case report |
| title_sort | management of a traumatic anorectal full thickness laceration a case report |
| topic | emergency surgery rectal trauma hip fractures crush injuries case reports |
| url | http://jtraumainj.org/upload/pdf/jti-2021-0049.pdf |
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