Hospital: 1Hospital Morales Meseguer, 2Hospital Universitario Virgen de la Arrixaca.
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Aut@r o Autores: I. Cases Susarte1, A. Moreno Pastor1, M. Tovar Perez2, M. Gayán Belmonte1, I. Gonzalez Moreno1, E. Gonzalez Lozano2.,
Presentación:
A 64-year-old man came to the emergency department for penetrating perianal trauma while trying to jump a metal fence. He had been waiting for more than one hour to the ambulance. He was conscious and hemodynamically stable. Physical examination showed a deep wound behind anal orifice of about 4 cm. There were data of active bleeding and presence of urine output through anal orifice. Abdominal computed tomography scan with intravenous contrast (portal and retarded phases) was performed. It showed pneumoretroperitoneum and presence of air in the urinary bladder. Furthermore, two defects in the anterior and posterior wall of the rectus were identified. In addition, there were also 3 defects of the bladder wall with the existence of a fistula between the bladder and the rectum. In the late phase there was extraperitoneal contrast leak secondary to a rupture of the urinary bladder. Laparotomy confirmed rectum perforation and extraperitoneal perforation of the bladder. Treatment was sigmoid colostomy and lateral cystostomy.
Discusión:
Impalement injuries of the rectum have been frequently reported. They may affect several organs which depend mostly on the entry site, the direction, and the nature of the penetrated object. However, combined rectal and bladder injuries after rectal impalement remain a rare condition because of the deep bladder position within the bony pelvis (1). The characteristics of these types of injury are the delay in seeking medical assistance and the vagueness of the medical history. If rectal perforation may easily be diagnosed by a rectal exam, the diagnosis of bladder perforation remains difficult mainly in the absence of specific urinary symptoms (1). In hemodynamically stable patients a triple contrast-enhanced CT (arterial, portal and delayed phase at 10 minutes) may be considered because lack of physical findings does not rule out intraabdominal injury (2).
Conclusión:
Impalement injuries of the rectum have been frequently reported. They may affect several organs which depend mostly on the entry site, the direction, and the nature of the penetrated object. However, combined rectal and bladder injuries after rectal impalement remain a rare condition because of the deep bladder position within the bony pelvis (1). The characteristics of these types of injury are the delay in seeking medical assistance and the vagueness of the medical history. If rectal perforation may easily be diagnosed by a rectal exam, the diagnosis of bladder perforation remains difficult mainly in the absence of specific urinary symptoms (1). In hemodynamically stable patients a triple contrast-enhanced CT (arterial, portal and delayed phase at 10 minutes) may be considered because lack of physical findings does not rule out intraabdominal injury (2).
Bibliografía:
– Benjelloun EB, Ahallal Y, Khatala K, Souiki T, Kamaoui I, Taleb KA. Rectal impalement with bladder perforation: A review from a single institution. Urol Ann. 2013,5(4):249-54. – Kim S, Linden B, Cendron M, Puder M. Pediatric anorectal impalement wi