Rectal Perforation due to Impalement Injury: A Case Report

Abstract

A 33-year-old man was presented with lower abdominal pain. He had fallen on his buttocks in a bamboo thicket. A 30cm long bamboo stump had penetrated and lodged in his buttocks. Tenderness and rigidity of the muscles were found in his lower abdominal wall. There was a wound to the right of the anus. Digital examination revealed a penetrating injury to his lower rectum, together with another wound in the upper rectum. Five hours after the accident, an emergency laparotomy was performed under the clinical diagnosis of perforated peritonitis. The laparotomy revealed a blood clot at the bottom of the pelvis. A 25×9mm hole was found in the rectal anterior wall, with a random scattered distribution of bamboo splinters. Primary anastomosis was difficult because of contamination, so we decided to close the hole and perform a colostomy, following saline irrigation. In the recent literature, primary anastomosis has been reportedly useful for rectal trauma. However, the presence and degree of contamination must be taken into account. Primary anastomosis for impalement injuries should thus be indicated with caution.