Rectal impalement with bladder perforation: A review from a single institution
A 23-year-old man was admitted to the hospital 4 h after falling on a wooden stake. He was complaining of an unbearable anal pain with rectal bleeding. He had neither hematuria nor abdominal pain. Physical examination showed a soft non-tender abdomen. Perineal examination could not be done as the patient refused any investigation without anesthesia. Nevertheless, we had been able to place a urine catheter which showed unclear urine without hematuria. RU was performed to exclude any bladder involvement. It showed passage of contrast into the extraperitoneal anterior wall of the rectum []. The patient was taken to the operative room. Examination under anesthesia showed a small laceration at the left anal margin extending into the anus. In the rectal exam, sphincter tonus was normal. At 7-8 cm from the anal verge, we found about 1-2 cm hole on the anterior wall of the rectum. Injection of the saline through the Foley catheter showed a leak through the posterior bladder wall into the rectum which confirmed the CT finding. There was no free air or contrast leak within the peritoneal cavity. Elective loop sigmoidostomy was performed. Rectum was sutured through the anal canal with 3/0 vicryl, followed by rectal washout. A large presacral drainage was also performed. The patient had an eventless postoperative course. The Foley catheter was removed on postoperative day 21. One month later, a control cystogram was performed showing no leak into the rectum. The colostomy was closed 2 months after the first surgery.