Balamurugan Ganesan, Bhagvat Shirish, Wagh Amol, Jawale Hemant, Reddy Keerthika, Jain Saurabh
Department of General Surgery, Grant Medical College and Sir JJ Group of Hospitals, Byculla, Mumbai, 400008, India.
Int J Surg Case Rep. 2021 Apr;81:105740. doi: 10.1016/j.ijscr.2021.105740. Epub 2021 Mar 11.
Rectal perforations due to foreign body impalement are infrequently encountered in practice. Accidental or intentional foreign body insertions pose a diagnostic challenge to surgeons and put them in demanding circumstances for successful extraction.
We report a case of a 60-year-old male with alleged history of accidental foreign body insertion into the rectum. Radiographs showed a linear metallic foreign body with crooked end. Computed Tomography (CT) with rectal contrast revealed contrast extravasation indicating anterior wall perforation of upper rectum. Patient was taken urgently for exploration and foreign body removal. Intra-operatively, bladder was injured inadvertently. Primary repair of enterotomy and loop sigmoid-ostomy was done besides bladder repair. Patient tested positive for COVID-19. Patient was observed in critical care unit for two days. Post-operative period was unremarkable apart from midline abdominal wound gape for which secondary closure was done. Patient was discharged with urinary catheter in-situ. Patient followed-up with a normal cystourethrogram and a well-functioning stoma. Stoma closure after two months was uneventful.
A thorough history and clinical examination is required and one should raise a high index of suspicion of perforation in patients with rectal foreign bodies, which should be managed appropriately and promptly to prevent sepsis and multi-organ dysfunction. Inadvertent bladder injuries are common with lower-midline incisions. However, give good results when repaired suitably.
The rationale behind this report is to explicate the complexity and hurdles in the surgical management of rectal foreign bodies causing impalement injury.
因异物刺入导致的直肠穿孔在实际临床中并不常见。意外或故意插入异物对外科医生的诊断构成挑战，且使其处于成功取出异物的艰难处境。
我们报告一例60岁男性病例，据称有意外将异物插入直肠的病史。X线片显示一个末端弯曲的线性金属异物。直肠造影计算机断层扫描（CT）显示造影剂外渗，提示直肠上段前壁穿孔。患者被紧急送往手术室进行探查和异物取出。术中，不慎损伤膀胱。除膀胱修复外，还对肠切开处进行了一期修复并做了乙状结肠袢式造口术。患者新冠病毒检测呈阳性。患者在重症监护病房观察了两天。术后除中线腹部伤口裂开并进行了二期缝合外，其余情况良好。患者留置导尿管出院。患者随访时膀胱尿道造影正常，造口功能良好。两个月后造口关闭顺利。
需要详细的病史和临床检查，对于直肠异物患者应高度怀疑穿孔，应进行适当且及时的处理以预防败血症和多器官功能障碍。下中线切口常伴有膀胱意外损伤。然而，适当修复后效果良好。
本报告的目的是阐明导致刺入伤的直肠异物手术治疗的复杂性和困难。
