Kamaleddine Imad, Schafmayer Clemens, Alwali Ahmed
Department of General, Visceral, Thoracic, Vascular and Transplant Surgery, University Medical Center Rostock, Rostock, Germany.
Ann Med Surg (Lond). 2025 Aug 2;87(9):6177-6180. doi: 10.1097/MS9.0000000000003648. eCollection 2025 Sep.
Accidental chemical injuries in medical settings are uncommon but can have devastating consequences. Formaldehyde (commonly in the form of formalin solution) is widely used as tissue fixative in clinics and laboratories. If inadvertently introduced into living tissue, formaldehyde causes rapid protein coagulation and tissue fixation, leading to cell death and necrosis. We present a rare case of rectal injury and perforation caused by accidental formaldehyde injection during a prostate biopsy.
A 70-year-old male underwent a transrectal prostate biopsy which was complicated by the accidental injection of formaldehyde 4% into the rectum. One week later, he presented to our clinic with persistent rectal pain and was found to have an extensive rectal wall necrosis with perforation. Prompt intervention was undertaken with broad-spectrum intravenous antibiotics, transanal surgical debridement of necrotic tissue, and endoscopic vacuum therapy (EVT) to manage the rectal defect. The patient's condition improved with each sequential sponge change over an 11-day period, leading to cavity closure and granulation. He was discharged in stable condition on postoperative day 14. Two months later the rectal wound had completely healed.
Accidental injection of formaldehyde into viable tissues is rare, but it can result in severe consequences. Early identification of the injury, followed by appropriate treatment (in our case, EVT), offered the best management approach and led to full recovery without the need for a diverting ostomy.
This case highlights a rare iatrogenic chemical injury with formaldehyde, its successful management with minimally invasive endoscopic vacuum therapy (EVT), and underscores the need for stringent precautions to prevent such hazardous incidents.
医疗环境中的意外化学损伤并不常见，但可能产生毁灭性后果。甲醛（通常以福尔马林溶液的形式）在诊所和实验室中广泛用作组织固定剂。如果不小心注入活组织中，甲醛会导致蛋白质迅速凝固和组织固定，从而导致细胞死亡和坏死。我们报告一例在前列腺活检过程中因意外注射甲醛导致直肠损伤和穿孔的罕见病例。
一名70岁男性接受经直肠前列腺活检，术中意外将4%的甲醛注入直肠，导致并发症。一周后，他因持续的直肠疼痛前来我院就诊，检查发现直肠壁广泛坏死并穿孔。我们立即采取了积极的干预措施，包括静脉注射广谱抗生素、经肛门手术清创坏死组织以及采用内镜负压治疗（EVT）来处理直肠缺损。在11天的时间里，随着每次更换海绵，患者的病情逐渐好转，最终腔隙闭合，创面肉芽生长。术后第14天，患者病情稳定出院。两个月后，直肠伤口完全愈合。
意外将甲醛注入活组织的情况很少见，但可能导致严重后果。早期识别损伤并随后进行适当治疗（在我们的病例中为EVT），提供了最佳的治疗方法，并使患者无需进行改道造口术即可完全康复。
本病例突出了甲醛导致的罕见医源性化学损伤，以及通过微创内镜负压治疗（EVT）成功治疗该损伤的案例，并强调了采取严格预防措施以防止此类危险事件发生的必要性。
