Case contribution: Dr Radhiana Hassan
Clinical:
- A 26 years old man
- Involved in an industrial accident, lower abdomen hit by pipe
- On admission; GCS 15/15, BP=138/78mmHg, PR= 78 bpm
- Complaint of lower abdominal pain
- No hematuria
CT scan findings:
- Extensive soft tissue injury at lower abdomen and pelvic region evidenced by marked soft tissue swelling and oedema (blue arrows. Also had left psoas muscle hematoma
- Free air are seen at the perirectal region on the right side (yellow arrows) with suspicious non-continuity of its wall (white arrow)
- Associated multiple and comminuted pelvic fractures
- Presence of moderate hemoperitoneum. No pneumoperitoneum.
Intraoperative findings:
- A rectum perforation is seen, hemoperitoneum 1 litre,
- Retroperitoneal hematoma, anterior abdominal wall hematoma,
- Urinary bladder perforation at 2 sites, 10 cm intraperitoneal and 4 cm extraperitoneal at both bladder dome
Diagnosis: Blunt abdominal trauma causing rectum injury
Discussion:
- Extraperitoneal rectal injury secondary to blunt trauma is very rare and usually seen in association with comminuted fractures of the pelvis or sacrum and evidence of intraperitoneal injury
- It is more difficult to be diagnosed
- As a retroperitoneal organ, the injury does not produce intraperitoneal free air as normally seen in intraperitoneal bowel injury
- Urinary bladder injury was missed in this case as no proper CT cystogram done. The injury should be suspected with the mechanism of injury and other associated injuries seen even when patient do not have hematuria.
