Perineal trauma from cassette tape boxes (case report)

Abstract

Two vehicles collided at an impact speed in excess of 160 m.p.h. All three occupants of one car sustained a perineal injury. We believe that the injuries were caused by the plastic boxes in which cassette tapes are stored. Case reports Patient IA 22-year-old woman was retrieved unconscious from the car. She had sustained both a serious head injury and a perineal injury. She had a large perineal haematoma with a central laceration without rectal or vaginal involvement. This injury was managed conservatively and healed without incident. Putimr 2A 24-year-old man was rescued from the back seat of the car. He had originally been sitting in the front passenger seat wearing a seatbelt. His injuries included a right-sided pneumothorax and a stable undisplaced crush fracture of the third lumbar vertebra.He had also sustained a major perineal injury involving the anus. After resuscitation, formal examination under anaesthesia revealed a complete disruption of the internal and external anal sphincters with the wound extending anterolaterally into the perineum. There was a minor split posteriorly. The injury was deep and extended to the ischial tuberosity on the right side.Primary repair of the sphincter was effected with interrupted mattress sutures of chromic catgut (Figure 1 ). The remaining perineal defect was packed with flavine gauze, and faecal diversion was achieved with a defunctioning left iliac fossa loop colostomy. Ten days after the initial injury, rectal examination revealed voluntary anal sphincter contraction. The patient was discharged from hospital to undergo a formal test of anal function 3 months later and closure of colostomy thereafter provjded continence is satisfactory. Putient 3The driver of the vehicle, a 25-year-old man, was found to have sustained severe lacerations, a fracture dislocation of the left hip and a right olecranon fracture. He had also sustained an injury to the perineum giving severe contusion to the base of the penis without laceration. The latter injury required no intervention. DiscussionThe original theory as to the cause of these unusual injuries was that the seat springs had been forced through the seat covers into the perineum of the occupants of the car. However, Figure 1 Anal sphincter disruption after repair in patient 2 a detailed police inspection showed that the seats had not been damaged in this way. The car did, however, contain many fragments of plastic derived from the covers of cassette tape boxes. The fire officer who extracted patient 2 from the car then reported that he had removed an arrow-shaped piece of plastic from the perineal wound of this patient.When these plastic fragments are examined it becomes apparent that they are capable of causing incised wounds, and we suggest that they were indeed the cause of the three perineal injuries sustained in this accident. A literature search and inquiries of the Police Transport and Road Research Laboratories have not revealed reports of any other similar injuries. Beard et al.' reported six severe pelvic injuries ass...