Abstract
Traumatic impalement anorectal injury in a child is rare and often associated with injuries to the pelvic and abdominal viscera. We report the case of a patient with impalement injury to the rectum. A 7-year-old boy suffered accidental trauma to the anus from an S-shaped metal hook hanging on a column when he jumped over a fence in a garden. After removing it himself, he was immediately brought to a regional hospital with anal pain and bleeding. Anorectal injury was suspected and he was transferred to our hospital. Penetrating rectal injury to the posterior side was diagnosed on the basis of proctoscopy findings. Abdominal computed tomography showed free air in the pararectal space of the pelvic cavity, but no evidence of intra-abdominal free air or urinary tract injury. The perforation of the posterior wall of the rectum including the internal anal sphincter was closed by primary suturing without colostomy. The postoperative course was uneventful and the patient was discharged on postoperative day 7. Impalement injury to the rectum has been reported for 64 children in Japan. Cases involving patients treated by primary repair without colostomy for pediatric transanal impalement injury are rare. According to the degree of perineal and anorectal impalement injuries, primary repair without colostomy may be an option and may lead to a good prognosis.
