Unusual extraperitoneal rectal injuries: a retrospective study

  • M. Gümüş
  • A. Böyük
  • M. Kapan
  • A. Onder
  • F. Taskesen
  • İ. Aliosmanoğlu
  • A. Tüfek
  • M. Aldemir
Original Article

Abstract

Purpose

Rectal injuries, which are rarely encountered because of the anatomic characteristics, occur due to penetrating traumas. In the current study, we aimed to present experiences gleaned from our clinic concerning rarely encountered unusual rectal injuries, including those cases presented for the first time.

Methods

Eleven patients who had been treated for unusual rectal injuries in the General Surgery Clinic of Dicle University between 2004 and 2011 were retrospectively reviewed.

Results

The reasons for rectal injuries included foreign bodies in four cases, sexual intercourse in three cases, iatrogenic injuries in two cases, electric shock in one case, and animal horns in one case. All cases had extraperitoneal rectal injuries and all injuries were grade 2 injuries, except for the electrical burn. Primary repair was adequate for the treatment of six patients. Four patients underwent primary repair and ostomy, whereas one of the patients underwent debridement and an ostomy. The patients recovered without complications, except for one patient with sphincter insufficiency.

Conclusion

The results of the current study suggested that primary repair is adequate in the patients with low-energy injuries and early presentation, whereas an ostomy is required for those with late presentation and for those with high-energy and destructive injuries.

Keywords

Rectum Injuries and wounds Trauma 

References

  1. 1.
    Steele SR, Wolcott KE, Mullenix PS, Martin MJ, Sebesta JA, Azarow KS, Beekley AC. Colon and rectal injuries during Operation Iraqi Freedom: are there any changing trends in management or outcome? Dis Colon Rectum. 2007;50:870–7.PubMedCrossRefGoogle Scholar
  2. 2.
    Cleary RK, Pomerantz RA, Lampman RM. Colon and rectal injuries. Dis Colon Rectum. 2006;49:1203–22.PubMedCrossRefGoogle Scholar
  3. 3.
    Demetriades D, Salim A. Colon and rectal trauma and rectal foreign bodies. In: Wolff BG, Fleshman JW, Beck DE, Pemberton JH, Wexner SD, editors. The ASCRS textbook of colon and rectal surgery. New York: Springer Science and Business Media, LLC; 2007. p. 322–34.CrossRefGoogle Scholar
  4. 4.
    Weinberg JA, Fabian TC, Magnotti LJ, Minard G, Bee TK, Edwards N, Claridge JA, Croce MA. Penetrating rectal trauma: management by anatomic distinction improves outcome. J Trauma. 2006;60:508–14.PubMedCrossRefGoogle Scholar
  5. 5.
    Bostick PJ, Johnson DA, Heard JF, Islas JT, Sims EH, Fleming AW, Sterling-Scott RP. Management of extraperitoneal rectal injuries. J Natl Med Assoc. 1993;85:460–3.PubMedGoogle Scholar
  6. 6.
    Crispen PL, Kansas BT, Pieri PG, Fisher C, Gaughan JP, Pathak AS, Mydlo JH, Goldberg AJ. Immediate postoperative complications of combined penetrating rectal and bladder injuries. J Trauma. 2007;62:325–9.PubMedCrossRefGoogle Scholar
  7. 7.
    Weber S, Mauch W, Kalayoglu M, Moon TD. Intraperitoneal and extraperitoneal bladder rupture secondary to rectal impalement. J Trauma. 1995;38:818–9.PubMedCrossRefGoogle Scholar
  8. 8.
    Orr CJ, Clark MA, Hawley DA, Pless JE, Tate LR, Fardal PM. Fatal anorectal injuries: a series of four cases. J Forensic Sci. 1995;40:219–21.PubMedGoogle Scholar
  9. 9.
    Waraich NG, Hudson JS, Iftikhar SY. Vibrator-induced fatal rectal perforation. N Z Med J. 2007;120:U2685.PubMedGoogle Scholar
  10. 10.
    Ameh EA. Anorectal injuries in children. Pediatr Surg Int. 2000;16:388–91.PubMedCrossRefGoogle Scholar
  11. 11.
    Bonnard A, Zamakhshary M, Wales PW. Outcomes and management of rectal injuries in children. Pediatr Surg Int. 2007;23:1071–6.PubMedCrossRefGoogle Scholar
  12. 12.
    Kadish HA, Schunk JE, Britton H. Pediatric male rectal and genital trauma: accidental and nonaccidental injuries. Pediatr Emerg Care. 1998;14:95–8.PubMedCrossRefGoogle Scholar
  13. 13.
    Kim S, Linden B, Cendron M, Puder M. Pediatric anorectal impalement with bladder rupture: case report and review of the literature. J Pediatr Surg. 2006;41:E1–3.PubMedCrossRefGoogle Scholar
  14. 14.
    Soto LJ 3rd, Saltzman DA. Rectal impalement: a case review. Minn Med. 2003;86:48–9.PubMedGoogle Scholar
  15. 15.
    Marti MC, Morel P, Rohner A. Traumatic lesions of the rectum. Int J Colorectal Dis. 1986;1:152–4.PubMedCrossRefGoogle Scholar
  16. 16.
    Shatnawi NJ, Bani-Hani KE. Management of civilian extraperitoneal rectal injuries. Asian J Surg. 2006;29:11–6.PubMedCrossRefGoogle Scholar
  17. 17.
    Ruiz del Castillo J, Sellés Dechent R, Millán Scheiding M, Zumárraga Navas P, Asencio Arana F. Colorectal trauma caused by foreign bodies introduced during sexual activity: diagnosis and management. Rev Esp Enferm Dig. 2001;93:631–4.PubMedGoogle Scholar
  18. 18.
    El-Ashaal YI, Al-Olama AK, Abu-Zidan FM. Trans-anal rectal injuries. Singapore Med J. 2008;49:54–6.PubMedGoogle Scholar
  19. 19.
    Huang WC, Jiang JK, Wang HS, Yang SH, Chen WS, Lin TC, Lin JK. Retained rectal foreign bodies. J Chin Med Assoc. 2003;66:607–12.PubMedGoogle Scholar
  20. 20.
    Wasadikar PP, Paunikar RG, Deshmukh SB. Bull horn injuries in rural India. J Indian Med Assoc. 1997;95:3–4, 16.PubMedGoogle Scholar
  21. 21.
    Idikula J, Moses BV, Sadhu D, Agarwal S, Jahan G, Thomas J. Bull horn injuries. Surg Gynecol Obstet. 1991;172:220–2.PubMedGoogle Scholar
  22. 22.
    Pal DK, Bora V, Bisoi SC, Dwivedi US. Urethrorectal fistula by bull horn injury. J Indian Med Assoc. 2002;100:47.PubMedGoogle Scholar
  23. 23.
    Ijaiya MA, Mai AM, Aboyeji AP, Kumanda V, Abiodun MO, Raji HO. Rectovaginal fistula following sexual intercourse: a case report. Ann Afr Med. 2009;8:59–60.PubMedCrossRefGoogle Scholar
  24. 24.
    Abasiattai AM, Etuk SJ, Bassey EA, Asuquo EE. Vaginal injuries during coitus in Calabar: a 10-year review. Niger Postgrad Med J. 2005;12:140–4.PubMedGoogle Scholar
  25. 25.
    Singhal SR, Nanda S, Singhal SK. Sexual intercourse: an unusual cause of rectovaginal fistula. Eur J Obstet Gynecol Reprod Biol. 2007;131:243–4.PubMedCrossRefGoogle Scholar
  26. 26.
    Castillo OA, Bodden E, Vitagliano G. Management of rectal injury during laparoscopic radical prostatectomy. Int Braz J Urol. 2006;32:428–33.PubMedCrossRefGoogle Scholar
  27. 27.
    Katz R, Borkowski T, Hoznek A, Salomon L, de la Taille A, Abbou CC. Operative management of rectal injuries during laparoscopic radical prostatectomy. Urology. 2003;62:310–3.PubMedCrossRefGoogle Scholar
  28. 28.
    McDowell GC 2nd, Wise HA 2nd. Rectal perforation as a complication of urethral instrumentation: 2 case reports. J Urol. 1988;140:605–6.PubMedGoogle Scholar
  29. 29.
    Levine JH, Longo WE, Pruitt C, Mazuski JE, Shapiro MJ, Durham RM. Management of selected rectal injuries by primary repair. Am J Surg. 1996;172:575–8; discussion 578–9.PubMedCrossRefGoogle Scholar
  30. 30.
    Berne JD, Velmahos GC, Chan LS, Asensio JA, Demetriades D. The high morbidity of colostomy closure after trauma: further support for the primary repair of colon injuries. Surgery. 1998;123:157–64.PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2011

Authors and Affiliations

  • M. Gümüş
    • 1
  • A. Böyük
    • 1
  • M. Kapan
    • 1
  • A. Onder
    • 1
  • F. Taskesen
    • 1
  • İ. Aliosmanoğlu
    • 1
  • A. Tüfek
    • 2
  • M. Aldemir
    • 1
  1. 1.Department of General Surgery, Faculty of MedicineDicle UniversityDiyarbakirTurkey
  2. 2.Department of Anesthesiology and Reanimation, Faculty of MedicineDicle UniversityDiyarbakirTurkey

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