Rectal impalement injury through the pelvis, abdomen and thorax

Abstract

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.

A forensic evaluation of impalement injuries

“…40,41 Insertion of a segment of metal pipe into the rectum which passed through the intestine and lodged in the right kidney in a 21-year-old man caused death in combination with ligature strangulation. 42 Objects such as broom or mop handles may be forcefully inserted into victims’ rectums; such a case involved a 39-year-old man who survived injuries to his rectum, dome of the bladder, mesentery, liver and right lung. 41…”

“…40,41 Insertion of a segment of metal pipe into the rectum which passed through the intestine and lodged in the right kidney in a 21-year-old man caused death in combination with ligature strangulation. 42 Objects such as broom or mop handles may be forcefully inserted into victims' rectums; such a case involved a 39-yearold man who survived injuries to his rectum, dome of the bladder, mesentery, liver and right lung. 41 Other types of assaults resulting in impalements involve a wide range of weapons including spears and arrows, as was demonstrated in a case from the FSSA files of the 27-year-old male who was shot through the chest with a spear gun.…”

Survival following an impalement injury through the perineum in association with high voltage electrical burns: A case report

“…Diverting colostomy has been the standard for anorectal injuries and bowel injuries [6][7][8][9]. The use of suprapubic catheterization for bladder repair is shifting more towards transurethral route even in the face of intraperitoneal bladder injury [10][11][12].…”

Thoracoabdominal impalement with criminal intent

“…Transanal injuries include iatrogenic cases and those related to sexual activities and violent actions. They often involve damage to multiple organs, depending mostly on the direction and nature of the penetrating object ( 7 - 9 ) . Impalement injuries are often associated with vascular and visceral damage, entailing significant morbidity and mortality.…”