복강내 및 복강외 방광파열과 소장파열이 동반된 직장천통

Abstract

Rectal impalement is even more unusual form of rectal injury. The typical mechanism of injury is a jump or a fall onto an impaling object, such as a fence or rake. This type of injury may range from simple rectal perforation with minimal soft tissue injury to severe rectal impalement, characterized by transfixion by the impaling object with resultant extensive perineal trauma and multiple organ damage. Because rectal injuries in civilians are uncommon, there remain considerable differences of opinion ahout the need for their repair as well as the optimal type of colostomy, method of drainage, and role of irrigation. We report a case of rectal impalement with associated intrapeirtoneal, extraperitoneal bladder perofration and ileal perforation caused hy through and through mechanism. Operatively, the anterior rectal tear was closed primarily transanally with interrupted two layer vicryl sutures. The diverting colostomy and presacral drainage were not performed. The defects of bladder were closed with running chromic sutures. A suprapubic tube was placed. Postoperatively, the patient did well and discharged on postoperative day 14. We believe this to he the first reported case of rectal impalement causing intraperitoneal, extraperitoneal bladder perforation and ileal perforation.