Abstract
Impalement rectal injuries with intraperitoneal organ injuries are rare. It is even rarer for such injuries to result in pelvic, abdominal and thoracic internal injuries. We present the case of a 39-year-old man who was admitted after an assault where a broken broomstick was inserted forcibly into his rectum. Surgery revealed penetration through the rectum, dome of the bladder, mesentery, liver and right lung. The patient survived following management by a multispecialty surgical team. Our literature review identified four similar cases with one fatality only. Prognosis seems to be good in these types of injuries provided there is an early presentation, the penetrating object is left in situ before the operation and, most importantly, an organised team approach to deal with the various injuries.
Highlights
Rectal injuries are rare as they only represent 9.6% of all colorectal trauma
Rectal injuries that penetrate the peritoneum are even less common as in a subsequent more comprehensive review of 175 cases, peritoneal penetration was recorded in only 70 cases
A 39-year-old man presented as an emergency following assault where a wooden handle of a cleaning mop had been forcibly inserted into his rectum while his head was slammed in a car door
Summary
A 39-year-old man presented as an emergency following assault where a wooden handle of a cleaning mop had been forcibly inserted into his rectum while his head was slammed in a car door. CT of the chest, abdomen and pelvis revealed a foreign body penetrating from the lower third of the rectum through the bladder, mesentery, stomach and liver, and to the right lung (Figs 1–3). The patient was taken to theatre and a chest drain was put in. This was followed by an emergency laparotomy and thoracotomy, a joint procedure involving three consultant surgeons in the fields of colorectal, cardiothoracic and hepatopancreatobiliary surgery. A wooden rod was seen to penetrate the rectum, dome of the bladder, root of the small bowel mesentery, transverse mesocolon, anterior and posterior walls of the stomach, inferior to superior surface of the liver through the porta hepatis, diaphragm and right lung.
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