International Journal of Current Research and Review
ISSN: 2231-2196 (Print)ISSN: 0975-5241 (Online)
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IJCRR - vol 05 issue 19, October, 2013

Pages: 88-90

Date of Publication: 19-Oct-2013


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TRAUMATIC RECTAL PERFORATION MANAGED BY SIMPLE CLOSURE WITHOUT COLOSTOMY

Author: A. Saravanan, G. Ganesan, K. Vivekananda Subramania Nathan

Category: Healthcare

Abstract:Generally traumatic rectal perforations are managed by doing diverting colostomy along with simple closure. Here we are reporting a case of traumatic rectal perforation which is managed by doing simple closure alone without diverting colostomy. About 95% of rectal injuries are due to penetrating injuries. Rectal injuries due to blunt trauma are rare but have more disastrous outcome .Extraperitoneal perforations of the lower part of the rectum are usually due to blunt injury and access to the area of perforation and closure is extremely tough. Hence extraperitoneal perforation has a bad prognosis and always requires diverting colostomy. Large intraperitoneal perforations of the upper part of the rectum involving the anterior wall are commonly associated with concomitant injuries and always require diverting colostomy. Patients presenting late are usually associated with severe peritoneal contamination and have bad prognosis and always require diverting colostomy. But small intraperitoneal perforations of the posterior wall of the upper part of the rectum are not commonly associated with concomitant injuries like in the patient reported below and do not require diverting colostomy, if the patient presents early without serious peritoneal contamination.

Keywords: Rectal perforations, simple closure, diverting colostomy.

Full Text:

INTRODUCTION

Rectal perforation is generally managed by doing diverting colostomy along with closure of perforation [1-9]. But so far there have been very few reports of managing rectal perforation by doing only simple closure without colostomy. Hence a case of rectal perforation managed by doing only simple closure without colostomy is reported here.

CASE REPORT

A thirteen year old boy had an accidental penetrating injury to his rectum by a wooden stick and presented within 18 hours of his injury with signs of generalized peritonitis, X-ray chest showed pneumoperitoneum (Fig-1).

Laparotomy was done immediately and 250ml of pus was found in the peritoneal cavity. A single small 1x1cm intraperitoneal perforation was found in the posterior wall of upper part of rectum (Fig-2) and was closed with single layer of interrupted 3.0 silk. The patient recovered uneventfully.

DISCUSSION

Perforation of the lower part of the rectum (extraperitoneal perforation) is extremely difficult to access by laparotomy and hence closure is extremely tough. But perforation in this patient was intraperitoneal lying at the upper most part of rectum and closure could be done easily. In addition, our patient presented within 18 hours of injury and there was no faecal contamination of peritoneal cavity. Hence a diverting colostomy was not done.

Patients with rectal perforation presenting early have good prognosis. But patients presenting late 

are usually associated with very severe and serious peritoneal contamination and have bad prognosis [9] and always require diverting colostomy.

About 95% of rectal injuries are due to penetrating injuries [5]. Rectal injuries due to blunt trauma are rare [5, 8] but have more disastrous outcome [5]. Extraperitoneal perforations occurring in the lower part of the rectum are usually due to blunt injury [5, 8, 10], commonly associated with fracture of pelvic bones [5, 8, 10] and sepsis of perirectal tissues [5, 10] and pelvic abscess [10]. Access to the area of perforation and closure is extremely tough while doing laparotomy. Hence extraperitoneal perforation has a bad prognosis and always requires diverting colostomy [5].

Large intraperitoneal perforations of anterior wall of the upper part of the rectum are commonly associated with concomitant injuries to urinary bladder [ 2], seminal vesicles[3], uterus,small bowel mesentery [ 11], sigmoid mesocolon [3,11] etc. and sometimes even evisceration of the small bowel [4,12] and always require diverting colostomy.

CONCLUSION

Small intraperitoneal perforations of the posterior wall of the upper part of the rectum  are not commonly associated with concomitant injuries like in this patient and do not require diverting colostomy, if the patient presents early without serious peritoneal contamination.

But all extraperitoneal perforations, large intraperitoneal perforations of the anterior wall associated with concomitant injuries and patients presenting late with very serious peritoneal contamination always require diverting colostomy along with closure of the perforation.

References:

  1. Emil Mammadov, Altan Alim, Mehmet Elicevik and Sinan Celayir., Self-induced penetrating rectal perforation by foreign body: an unusual event in childhood., Annals of Pediatric Surgery 2011, 7:25–26.
  2. Mahmoud Aghaei Afshar, Foroogh Mangeli and Akram Nakheai., A Rare Case of Anorectal Injury with Ruptured Bladder and Rectum but Normal Anal Sphincter.,J Clin Case Rep 2012, 2:14.
  3. Major D S Jackson., Accidental Impalement Injuries of the Intraperitoneal Rectum caused by the Barrel of the Self Loading Rifle., J R Army Med Corps 1985; 131: 164-166.
  4. Neil R Price, S V Soundappan, Anthony L Sparnon and Danny T Cass., Swimming pool filter-induced transrectal evisceration in children: Australian experience., MJA?.Volume 192 Number 9. 3 May 2010; 534-536.
  5. Isaac Chun-Jen Chen, Hsin-Chin Shih, Yi-Szu Wen., Extraperitoneal Rectal Perforation without Perineal Wound or Pelvic Fracture., J Chin Med Assoc 2004;67:637-639.
  6. Ayeed Al-Qahtani ; Abdulkarim El-Wassabi ; Abdulrahman Al-Bassam .., Mercury-In-Glass Thermometer As A Cause Of Neonatal Rectal Perforations: A Report Of Three Cases And Review Of The Literature…, Annals of Saudi Medicine, Vol 21, Nos 1-2, 2001
  7. Charles G. Roland, Arnold G. Rogers.., Rectal Perforations After Enema Administration, canad.M.A.J.nov.15,1959, vol.81.
  8. Rachel M. Gomes, Jayesh Kudchadkar,Edwin Araujo, Trupti Gundawar,Anorectal avulsion: report of a rare case of rectal injury, Annals of Gastroenterology (2013) 26, 1
  9. Aditya Yelikar ,Tejinder Singh Chhabda , Pravin Suryawanshi …,Laparoscopic Management of Rectal Perforation Secondary To Self Induced Foreign Body – A Rare Case Report …,IJSR - International Journal Of Scientific Research  Volume :2 Issue :1 Jan 2013 .ISSN No 2277 – 8179.
  10. J F Nolan., Delayed presentation of rectal perforation. , Journal of the Royal Society of Medicine Volume 83 November 1990; 744-745.
  11. Karger B, Teige K, Bajanowski T. Bizarre impalement fatalities—where is the implement? J Forensic Sci 2002;47(2):389–391.
  12. Naima Zamir, Ahmed Sharif, M.Aqil Soomro, Soofia Ahmed And Jamshed Akhtar, Rectal Perforation in Children, Journal of The College of Physicians and Surgeons Pakistan 2008, Vol. 18 (1): 66-67.

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Best Article Award

A Study by Juna Byun et al. entitled "Study on Difference in Coronavirus-19 Related Anxiety between Face-to-face and Non-face-to-face Classes among University Students in South Korea" is awarded Best Article for Vol 12 issue 16
A Study by Sudha Ramachandra & Vinay Chavan entitled "Enhanced-Hybrid-Age Layered Population Structure (E-Hybrid-ALPS): A Genetic Algorithm with Adaptive Crossover for Molecular Docking Studies of Drug Discovery Process" is awarded Best article for Vol 12 issue 15
A Study by Varsha M. Shindhe et al. entitled "A Study on Effect of Smokeless Tobacco on Pulmonary Function Tests in Class IV Workers of USM-KLE (Universiti Sains Malaysia-Karnataka Lingayat Education Society) International Medical Programme, Belagavi" is awarded Best article of Vol 12 issue 14, July 2020
A study by Amruta Choudhary et al. entitled "Family Planning Knowledge, Attitude and Practice Among Women of Reproductive Age from Rural Area of Central India" is awarded Best Article for special issue "Modern Therapeutics Applications"
A study by Raunak Das entitled "Study of Cardiovascular Dysfunctions in Interstitial Lung Diseas epatients by Correlating the Levels of Serum NT PRO BNP and Microalbuminuria (Biomarkers of Cardiovascular Dysfunction) with Echocardiographic, Bronchoscopic and HighResolution Computed Tomography Findings of These ILD Patients" is awarded Best Article of Vol 12 issue 13 
A Study by Kannamani Ramasamy et al. entitled "COVID-19 Situation at Chennai City – Forecasting for the Better Pandemic Management" is awarded best article for  Vol 12 issue 12
A Study by Muhammet Lutfi SELCUK and Fatma COLAKOGLU entitled "Distinction of Gray and White Matter for Some Histological Staining Methods in New Zealand Rabbit's Brain" is awarded best article for  Vol 12 issue 11
A Study by Anamul Haq et al. entitled "Etiology of Abnormal Uterine Bleeding in Adolescents – Emphasis Upon Polycystic Ovarian Syndrome" is awarded best article for  Vol 12 issue 10
A Study by Arpita M. et al entitled "Estimation of Reference Interval of Serum Progesterone During Three Trimesters of Normal Pregnancy in a Tertiary Care Hospital of Kolkata" is awarded best article for  Vol 12 issue 09
A Study by Ilona Gracie De Souza & Pavan Kumar G. entitled "Effect of Releasing Myofascial Chain in Patients with Patellofemoral Pain Syndrome - A Randomized Clinical Trial" is awarded best article for  Vol 12 issue 08
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A Study by K. Krupashree et. al. entitled "Protective Effects of Picrorhizakurroa Against Fumonisin B1 Induced Hepatotoxicity in Mice" is awarded best article for issue Vol 10 issue 20
A study by Mithun K.P. et al "Larvicidal Activity of Crude Solanum Nigrum Leaf and Berries Extract Against Dengue Vector-Aedesaegypti" is awarded Best Article for Vol 10 issue 14 of IJCRR
A study by Asha Menon "Women in Child Care and Early Education: Truly Nontraditional Work" is awarded Best Article for Vol 10 issue 13
A study by Deep J. M. "Prevalence of Molar-Incisor Hypomineralization in 7-13 Years Old Children of Biratnagar, Nepal: A Cross Sectional Study" is awarded Best Article for Vol 10 issue 11 of IJCRR
A review by Chitra et al to analyse relation between Obesity and Type 2 diabetes is awarded 'Best Article' for Vol 10 issue 10 by IJCRR. 
A study by Karanpreet et al "Pregnancy Induced Hypertension: A Study on Its Multisystem Involvement" is given Best Paper Award for Vol 10 issue 09
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A Study by Neha Garg et al. entitled "Optimization of the Response to nCOVID-19 Pandemic in Pregnant Women – An Urgent Appeal in Indian Scenario" published in Vol 12 issue 09

A Study by Sana Parveen and Shraddha Jain entitled "Pathophysiologic Enigma of COVID-19 Pandemic with Clinical Correlates" published in Vol 12 issue 13

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A Study by Madhan Jeyaraman et al. entitled "Vitamin-D: An Immune Shield Against nCOVID-19" published in Vol 12 issue 09

Study by Dheeraj Kumar Chopra et al. entitled "Lipid-Based Solid Dispersions of Azilsartan Medoxomil with Improved Oral Bioavailability: In Vitro and In Vivo Evaluation" published in Vol 12 issue 19


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