Meister F A, Amygdalos I, Neumann U P, Lurje G
Department of Surgery and Transplantation, University Hospital RWTH-Aachen , Aachen , Germany.
Ann R Coll Surg Engl. 2017 Jul;99(6):e191-e192. doi: 10.1308/rcsann.2017.0109.
Rectal foreign body insertion is a common condition in emergency surgery, which often requires surgical intervention. Here we report a clinical case of rectal foreign body insertion as a rare cause of persistent lumbosacral plexus injury. A 72-year-old man presented to the emergency department complaining of acute bilateral paraplegia with loss of sensation in both legs, as well as total urinary retention. The patient underwent abdominal computed tomography, which showed a rectal foreign body measuring 13 × 11.5 × 10 cm in the lower abdomen and pelvis. Extraluminal assistance through a median laparotomy was required after unsuccessful attempts at transanal recovery alone. After removal of the foreign body, the rectal wall and anorectal sphincter were massively dilated, with severe bruising of the rectal mucosa on proctoscopy. A protective loop-ileostomy was performed. The sacral plexus is located posteriorly in the pelvis. Physiologically, the nerves are well protected by surrounding anatomical structures. Post-traumatic lumbosacral plexus injuries with paraplegia, urinary retention and anorectal sphincter insufficiency occur quite frequently after heavy traffic accidents. Lumbosacral plexus injury as a result of rectal foreign body insertion is rare. Severe neurological deficits through rectal foreign body insertion are rare but known medical conditions. To the best of our knowledge, this is the first reported case of severe and persistent post-traumatic lumbosacral plexus injury through a rectal foreign body.
直肠异物插入是急诊手术中的常见情况，通常需要手术干预。在此，我们报告一例直肠异物插入导致持续性腰骶丛损伤的罕见临床病例。一名72岁男性因急性双侧截瘫、双腿感觉丧失以及完全性尿潴留就诊于急诊科。患者接受了腹部计算机断层扫描，结果显示在下腹部和骨盆中有一个尺寸为13×11.5×10 cm的直肠异物。仅通过经肛门取出异物失败后，需要通过正中剖腹术进行腔外辅助。取出异物后，直肠壁和肛门直肠括约肌明显扩张，直肠镜检查显示直肠黏膜严重瘀伤。遂进行了保护性回肠造口术。骶丛位于骨盆后部。从生理上讲，神经受到周围解剖结构的良好保护。严重交通事故后，创伤后腰骶丛损伤伴截瘫、尿潴留和肛门直肠括约肌功能不全的情况相当常见。因直肠异物插入导致的腰骶丛损伤较为罕见。通过直肠异物插入导致严重神经功能缺损虽属罕见，但却是已知的医学情况。据我们所知，这是首例通过直肠异物导致严重且持续性创伤后腰骶丛损伤的报告病例。
