Diagnostic Laparoscopy and Laparoscopic Diverting Sigmoid Loop Colostomy in Penetrating Extraperitoneal Rectal Injury: A Case Report

Abstract

Laparoscopy has been one of the most effective modalities in various surgical situations, although its use in trauma patients has some limitations. The benefits of laparoscopy include cost-effectiveness, shorter length of hospital stay, and less postoperative pain. This report describes diagnostic laparoscopy and laparoscopic diverting sigmoid loop colostomy in penetrating extraperitoneal rectal injury. A 41-year-old male presented with perineal pain following penetrating trauma caused by a tree limb. Computed tomography showed air density in the perirectal space and retroperitoneum. As his vital signs were stable, we performed diagnostic laparoscopy and confirmed no intraperitoneal perforation. Therefore, laparoscopic diverting sigmoid loop colostomy was performed. He was discharged without any complications despite underlying hepatitis C-related cirrhosis. Colostomy closure was performed 3 months later.

The floating rectum

“…1 Additionally, laparoscopy and diverting loop sigmoid colostomy is a safe and effective surgery for extra-peritoneal rectal injuries. 5,6 Laparotomy is usually not required for extraperitoneal rectal injuries if no blood or foreign body are found during laparoscopy. 6 Other techniques such as distal rectal washout and pre-sacral drainage are also often mentioned in the literature but show no additional benefit in managing extra-peritoneal rectal injuries.…”

“…However, the current literature supports primary reconstruction for extra‐peritoneal rectal injuries where possible 1 . Additionally, laparoscopy and diverting loop sigmoid colostomy is a safe and effective surgery for extra‐peritoneal rectal injuries 5,6 . Laparotomy is usually not required for extraperitoneal rectal injuries if no blood or foreign body are found during laparoscopy 6 .…”