Rectovesical Tract Caused by Trans-Anal Metallic Rod Impalement

El-Ashaal, Yousef; Saadeldin, Yousif A.; Abu‐Zidan, Fikri M.

doi:10.1097/ta.0b013e31816bbe61

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“…A PubMed search of the literature found 11 reports with combined rectal and bladder injuries due to rectal impalement. [ 3 4 5 6 7 8 9 10 ] Details of all the 11 cases along with the current patients are summarized in Table 1 and Table 2 summarizes the results of clinical symptoms, radiologic findings, treatment, and outcome data of the patients. The mean age of the patients was 28.1 years (range 9-57 years) and the male: female ratio was 12:2.…”

Section: Resultsmentioning

confidence: 99%

Rectal impalement with bladder perforation: A review from a single institution

et al. 2013

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Context:Impalement injuries of the rectum with bladder perforation have been rarely reported. Such lesions have been associated with increased postoperative morbidity. A well-conducted preoperative evaluation of the lesions tends to prevent such complications.Aims:To increase awareness about patients with rectal impalement that involve bladder injuries and to examine the significance of thorough clinical examination and complementary investigation for these patients’ management.Materials and Methods:Retrospectively, we identified three patients with rectal impalement and bladder perforation treated in University Hospital Hassan II, Fez, Morocco. We recorded the symptoms, subsequent management, and further follow-up for each patient. All available variables of published cases were reviewed and analyzed.Results:Evident urologic symptoms were present in only one patient. Bladder perforation was suspected in two other patients on the basis of anterior rectal perforation in digital exam. Retrograde uroscanner could definitely confirm the diagnosis of bladder perforation. Fecal and urine diversion was the basis of the treatment. No postoperative complications were noted. We have reviewed 14 previous reports. They are presented mainly with urine drainage through the rectum. Radiologic investigation (retrograde cystography and retrograde uroscanner) confirmed bladder perforation in 10 patients (71.4%). Unnecessary laparotomy was performed in six patients (42.8%). Fecal diversion and urinary bladder decompression using urethral catheter were the most performed procedures in bladder perforation [6/14 patients (42.8%)]. No specific postoperative complications were reported.Conclusions:A high index of clinical suspicion is required to make the diagnosis of bladder perforation while assessing patients presenting with rectal impalement. Meticulous preoperative assessment is the clue of successful management.

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