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

Abstract

Context:Impalement injuries of the rectum with bladder perforation have been rarely reported. Such lesions have been associated with increased postoperative morbidity. A well-conducted preoperative evaluation of the lesions tends to prevent such complications.Aims:To increase awareness about patients with rectal impalement that involve bladder injuries and to examine the significance of thorough clinical examination and complementary investigation for these patients’ management.Materials and Methods:Retrospectively, we identified three patients with rectal impalement and bladder perforation treated in University Hospital Hassan II, Fez, Morocco. We recorded the symptoms, subsequent management, and further follow-up for each patient. All available variables of published cases were reviewed and analyzed.Results:Evident urologic symptoms were present in only one patient. Bladder perforation was suspected in two other patients on the basis of anterior rectal perforation in digital exam. Retrograde uroscanner could definitely confirm the diagnosis of bladder perforation. Fecal and urine diversion was the basis of the treatment. No postoperative complications were noted. We have reviewed 14 previous reports. They are presented mainly with urine drainage through the rectum. Radiologic investigation (retrograde cystography and retrograde uroscanner) confirmed bladder perforation in 10 patients (71.4%). Unnecessary laparotomy was performed in six patients (42.8%). Fecal diversion and urinary bladder decompression using urethral catheter were the most performed procedures in bladder perforation [6/14 patients (42.8%)]. No specific postoperative complications were reported.Conclusions:A high index of clinical suspicion is required to make the diagnosis of bladder perforation while assessing patients presenting with rectal impalement. Meticulous preoperative assessment is the clue of successful management.

Anorectal injuries in children: a 20-year experience in two centers

“…While up to 95 % of extraperitoneal bladder trauma is associated with pelvic fracture, perforation of the bladder after rectal impalement is rare [8]. Blood at the urinary meatus or gross hematuria strongly suggests an associated lower urinary tract injury but evident urologic symptoms may be absent [8,9]. Injury to the bladder should be evaluated with retrograde urethrography or cystoscopy [1].…”

Bladder perforation with rectal impalement injury: Usefulness of exploratory laparoscopy for excluding intraperitoneal perforation

“…3 However, Benjelloun et al reported that exploratory laparotomy to diagnose IP injuries was not necessary in most cases and its role could not be understood in the absence of clinical and radiologic findings. 4 …”