Rectal impalement with bladder perforation: A review from a single institution
A previously healthy 15-year-old boy presented to University Hospital Hassan II of Fez. Three hours ago, he had fallen onto the handlebar of the bicycle and sustained a penetrating injury of the rectum. The patient and his parents reported copious watery drainage expelled per rectum. No sign of hematuria was reported as he had not voided since the trauma. Upon arrival at our emergency room, the patient complained only of pelvic pain and inability to void. No abdominal pain was reported by the patient. On physical examination, the abdomen was free of tenderness. Rectal exam revealed about 2-3 cm defect in the anterior rectal wall at 6-7 cm of the anal verge. RU demonstrated a communication between extraperitoneal posterior bladder wall and the anterior rectal wall. Foley catheter was inserted for bladder decompression. We temporarily decided to avoid diverting colostomy by the close surveillance of patient. During this period, no signs of hyperthermia, abdominal pain, or abnormal changes in the urine were observed. Two weeks after the injury, a control cystogram was performed, which showed no communication between the rectum and urinary bladder. Foley catheter was removed 1 week later.