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 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 sta-bilized with external fixators, and it was decided to proceed with loop sigmoid colostomy. A trac-tioned 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.

[1]  M. Hattori,et al.  Anorectal injury related to a personal watercraft: a case report and literature review , 2020, Surgical Case Reports.

[2]  F. Brenneman,et al.  Minimally invasive approach to low-velocity penetrating extraperitoneal rectal trauma , 2020, Trauma surgery & acute care open.

[3]  Óscar E Pérez-Morales,et al.  A novel approach for rectal trauma. The use of a transanal platform to repair a combined high-velocity rectal gun fire wound , 2020, Journal of Coloproctology.

[4]  D. Karadimos,et al.  Conservative management of a traumatic non-destructive grade II extraperitoneal rectal injury following motor vehicle collision , 2019, Trauma case reports.

[5]  R. Kiran,et al.  Rectal trauma injuries: outcomes from the U.S. National Trauma Data Bank , 2018, Techniques in Coloproctology.

[6]  J. Holcomb,et al.  Contemporary management of rectal injuries at Level I trauma centers: The results of an American Association for the Surgery of Trauma multi-institutional study , 2017, The journal of trauma and acute care surgery.

[7]  W. Lee,et al.  Extraperitoneal Rectal Laceration Secondary to Blunt Trauma: Successful Transanal Endoscopic Repair with Hemoclips , 2017, Chinese Medical Journal.

[8]  Carlos V. R. Brown,et al.  Penetrating Injuries to the Colon and Rectum , 2015, Current Trauma Reports.

[9]  S. Steele,et al.  Traumatic Injury of the Colon and Rectum: The Evidence vs Dogma , 2011, Diseases of the colon and rectum.

[10]  Andre Chow,et al.  The morbidity surrounding reversal of defunctioning ileostomies: a systematic review of 48 studies including 6,107 cases , 2009, International Journal of Colorectal Disease.

[11]  G. Di Flumeri,et al.  Anorectal and perineal injury due to a personal watercraft accident: case report and review of the literature. , 2009, Chirurgia italiana.

[12]  B. Roche,et al.  [Traumatic lesions of the anorectum]. , 1998, Swiss surgery = Schweizer Chirurgie = Chirurgie suisse = Chirurgia svizzera.

[13]  J. Levine,et al.  Management of selected rectal injuries by primary repair. , 1996, American journal of surgery.

[14]  H. Champion,et al.  Organ injury scaling. , 1995, The Surgical clinics of North America.