Impalement injury of anorectum-A rare presentation

Abstract

Introduction: A rectal impalement injury is a rare type of penetrating injury that involves a solid object being forcefully inserted through anal opening. The removal of such injuries should be planned carefully with preparedness to assess and manage associated injuries in the pelvis and peri-anal region.

Case description: An elderly female, around 65 years old, had a history of accidental penetration of an iron rod into her anal orifice. The patient was hemodynamically stable, and the distal end of the penetrated rod was visible in the anal verge on arrival. On evaluation, we found that the object had perforated the posterior wall of the middle 1/3rd of the rectum and had traversed retroperitoneally, bypassing all major vessels and viscera.

Discussion: We performed exploratory laparotomy, and the iron rod was extracted from the anal canal under vision, and a diversion colostomy of the sigmoid colon was performed. The patient had an uneventful recovery, and the reversal of the sigmoid colostomy was done after 3 months.

Conclusion: Rectal impalement injuries are rare and serious. It requires a multidisciplinary approach involving a general surgeon, a vascular surgeon, and a urologist since it is associated with a higher incidence of involving major pelvic organs and vessels. In our case, the penetrating object had bypassed all major vessels, which is a rare occurrence.

Keywords: Case report; Impalement injury; Rare presentation; Rectal perforation; Trans-anal impalement.

Fig. 1

Clinical picture. Shows impaling object penetrating the anal orifice, Foleys catheter in-situ.

Fig. 2

Abdominal CT scan. Showing image of abdominal CT scan with metallic foreign body.

Fig. 3

Abdominal CT scan with reconstruction. Abdominal CT image with reconstruction showing course of metallic foreign body bypassing ureter.

Fig. 4

Abdominal CT with reconstruction. Abdominal CT image with reconstruction showing course of metallic foreign body bypassing left iliac vessels.

Fig. 5

Tip of the iron rod in the retro peritoneum. Showing upper end of metallic foreign body in the retroperitoneum, lower pole of left kidney.

Fig. 6

Full length of the iron rod. Impaling foreign body after extraction.