Anorectal Avulsion: Reporting a Rare Case of Rectal Trauma and Review of the Literature

Konstantinos Bouliaris,Konstantinos Malizos,Panagiotis Papamichalis,Evangelos Alexiou,Dimitrios Papadopoulos,Ioannis Staikos,Matthaios Efthimiou,Antonios Koutalos,Anna Ziogkou,Paraskevi Hatzikomnitsa

doi:10.31487/j.scr.2019.06.14

Abstract

Background: Anorectal avulsion is a rare rectal injury and it is the result of severe blunt pelvic trauma. In this type of injury, the anus and sphincters are detached from the perineum and are displaced cranially and ventrally. Treatment is challenging and only a few reports are available. Case presentation: We report a case of 49-year-old male patient who was referred to our hospital in a septic condition 10 days after a complex crush pelvic trauma with anorectal avulsion. The treatment included external pelvic fixation, control of the pelvic sepsis, sigmoidostomy and negative-pressure therapy of the perineal wound. Salvage of the anus could not be done. The patient was discharged after 90 days suffering from neurologic deficits of both lower extremities and he followed a long-term rehabilitation program. Conclusion: Severe perineal injuries with anorectal avulsion are associated with significant morbidity and mortality. Due to the rarity of this entity treatment is not standardised and requires a multidisciplinary approach involving general surgeons, orthopaedics, intensivists and rehabilitators. Any effort for anal reconstruction should be done, if possible, early in the treatment course.

Highlights

Anorectal avulsion is a rare rectal injury and it is the result of severe blunt pelvic trauma
Case presentation: We report a case of 49-year-old male patient who was referred to our hospital in a septic condition 10 days after a complex crush pelvic trauma with anorectal avulsion
Anorectal avulsion is a rare rectal trauma where the anus and sphincters are detached from the perineum because of divarication of the levator ani and are displaced cranially and ventrally

Summary

Background

Rectal injuries are relatively uncommon with a reported incidence of approximately 1% -3% in civilian trauma centers. As soon as the patient was haemodynamically stabilized a contrast enhanced CT scan of the abdomen and pelvis was performed (Figure 1) During his stay in the ICU he received multiple blood transfusions and he was on mechanical ventilation. Clinical examination of the perineum showed signs of infection with soft tissue necrosis (Figure 2) After haemodynamic stabilization another CT of the abdomen and pelvis was performed which showed decrease in the volume of the retroperitoneal haematoma and no signs of intraperitoneal abscess. These involved axonal damage of both peroneal and right tibial nerve together with paresis of the left femoral nerve, resulting in reduced mobility

Findings

Discussion

Conclusion