Impalement rectal injuries with intraperitoneal organ injuries are rare. It is even rarer for such injuries to result in pelvic, abdominal and thoracic internal injuries. We present the case of a 39-year-old man who was admitted after an assault where a broken broomstick was inserted forcibly into his rectum. Surgery revealed penetration through the rectum, dome of the bladder, mesentery, liver and right lung. The patient survived following management by a multispecialty surgical team. Our literature review identified four similar cases with one fatality only. Prognosis seems to be good in these types of injuries provided there is an early presentation, the penetrating object is left in situ before the operation and, most importantly, an organised team approach to deal with the various injuries.

Lower gastrointestinal hemorrhage often produces diagnostic difficulty in children. Endoscopy, radionuclide scans, computed tomography/magnetic resonance angiography, and conventional angiography have been the usual armamentarium for locating the site of bleeding. In recent times, laparoscopy has offered an effective tool for diagnosing various intra-abdominal, especially extraluminal, pathologies elusive to other modalities of diagnosis. In this paper, we present a case of massive hemorrhage from an ileal duplication cyst in a 10-year-old Saudi boy diagnosed and treated by laparoscopy. We believe this is the first such reported case from the Kingdom of Saudi Arabia.