Abstract
Introduction. The objective of this case report is to illustrate a severe perineal impalement injury, associated with anorectal avulsion and hemorrhagic shock. Results. A 32-year-old male patient was referred to our hospital for an impalement perineal trauma, associated with complex pelvic fracture and massive perineal soft tissue destruction and anorectal avulsion. On arrival, the systolic blood pressure was 85 mm Hg and the hemoglobin was 7.1 g/dL. The patient was transported to the operating room, and perineal lavage, hemostasis, and repacking were performed. After 12 hours in the Intensive Care Unit, the abdominal ultrasonography revealed free peritoneal fluid. We decided emergency laparotomy, and massive hemoperitoneum due to intraperitoneal rupture of pelvic hematoma was confirmed. Pelvic packing controlled the ongoing diffuse bleeding. After 48 hours, the relaparotomy with packs removal and loop sigmoid colostomy was performed. The postoperative course was progressive favorable, with discharge after 70 days and colostomy closure after four months, with no long-term complications. Conclusions. Severe perineal injuries are associated with significant morbidity and mortality. Their management in high volume centers, with experience in colorectal and trauma surgery, allocating significant human and material resources, decreases the early mortality and long-term complications, offering the best quality of life for patients.
Highlights
The objective of this case report is to illustrate a severe perineal impalement injury, associated with anorectal avulsion and hemorrhagic shock
Severe rectal injuries are rarely met into the clinical practice even in tertiary emergency centers, but when present, they are usually associated with significant morbidity and mortality
We presented a case of an active young man with severe perineal penetrating trauma and anorectal injury successfully managed by a multidisciplinary team highly experienced in colorectal and trauma surgery
Summary
Severe rectal injuries are rarely met into the clinical practice even in tertiary emergency centers, but when present, they are usually associated with significant morbidity and mortality. When facing severe pelvic and perineal injuries, the trauma surgeon should choose appropriate management according to the degree of rectal wall destruction, fecal contamination, hemodynamic status, and pelvic instability [2, 3]. The objective of this case report is to illustrate a severe perineal penetrating injury, associated with massive soft tissues pelvic destructions, hemorrhagic shock, and longterm morbidities
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