Extraperitoneal bladder rupture secondary to rectal impalement

Abstract

Impalement injury to both the urinary bladder and the rectum is a rare occurrence. A 45-year-old man was referred to our hospital because he had been stabbed through the internal femoral skin by a steel bar. Retrograde cystography and computed tomography failed to demonstrate bladder rupture. We carried out cystoscopy (CS) because of the existence of gross hematuria and found a penetrating wound in the posterior wall. Colon fiberscopy revealed two wounds in the rectum, one of which communicated with the bladder. A diagnostic laparoscopy revealed no associated injuries in the peritoneal cavity. Vesicorectal injury was diagnosed and treatment included transanal closure of fistulas and indwelling ureteral and urethral catheters. Postoperative CS revealed complete closure of the injury.

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

“…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.…”

Impalement Injury of the Urinary Bladder: A Case Report

“…Many series of patients with extraperitoneal bladder rupture managed by a nonoperative or conservative approach have been reported [8]. Nonoperative management implies simple catheter drainage and clinical observation.…”

Transdiaphragmatic Thoracic Injury Secondary to Anorectal Impalement

“…Whereas almost any organ can be injured in association with rectal gunshot wounds, impalement injuries to the rectum are usually only associated with genitourinary, mesenteric, and small bowel injuries. 2 We report a remarkable rectal impalement injury with associated transabdominal, transhepatic, and transdiaphragmatic penetration.…”

“…In impalement wounds, genitourinary, mesenteric, and small bowel injuries have been previously reported. 2 Injuries to other structures, especially outside the pelvis, are unusual. Cases have been reported in forensic medical reports of injuries associated with hepatic injury 3 and a dramatic case of transperineal intrathoracic penetration with multiple associated injuries including the intrathoracic esophagus has been published.…”