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Abstract：
UNASSIGNED: Rectal perforations due to foreign body impalement are infrequently encountered in practice. Accidental or intentional foreign body insertions pose a diagnostic challenge to surgeons and put them in demanding circumstances for successful extraction.
METHODS: We report a case of a 60-year-old male with alleged history of accidental foreign body insertion into the rectum. Radiographs showed a linear metallic foreign body with crooked end. Computed Tomography (CT) with rectal contrast revealed contrast extravasation indicating anterior wall perforation of upper rectum. Patient was taken urgently for exploration and foreign body removal. Intra-operatively, bladder was injured inadvertently. Primary repair of enterotomy and loop sigmoid-ostomy was done besides bladder repair. Patient tested positive for COVID-19. Patient was observed in critical care unit for two days. Post-operative period was unremarkable apart from midline abdominal wound gape for which secondary closure was done. Patient was discharged with urinary catheter in-situ. Patient followed-up with a normal cystourethrogram and a well-functioning stoma. Stoma closure after two months was uneventful.
UNASSIGNED: A thorough history and clinical examination is required and one should raise a high index of suspicion of perforation in patients with rectal foreign bodies, which should be managed appropriately and promptly to prevent sepsis and multi-organ dysfunction. Inadvertent bladder injuries are common with lower-midline incisions. However, give good results when repaired suitably.
CONCLUSIONS: The rationale behind this report is to explicate the complexity and hurdles in the surgical management of rectal foreign bodies causing impalement injury.
METHODS: We report a case of a 60-year-old male with alleged history of accidental foreign body insertion into the rectum. Radiographs showed a linear metallic foreign body with crooked end. Computed Tomography (CT) with rectal contrast revealed contrast extravasation indicating anterior wall perforation of upper rectum. Patient was taken urgently for exploration and foreign body removal. Intra-operatively, bladder was injured inadvertently. Primary repair of enterotomy and loop sigmoid-ostomy was done besides bladder repair. Patient tested positive for COVID-19. Patient was observed in critical care unit for two days. Post-operative period was unremarkable apart from midline abdominal wound gape for which secondary closure was done. Patient was discharged with urinary catheter in-situ. Patient followed-up with a normal cystourethrogram and a well-functioning stoma. Stoma closure after two months was uneventful.
UNASSIGNED: A thorough history and clinical examination is required and one should raise a high index of suspicion of perforation in patients with rectal foreign bodies, which should be managed appropriately and promptly to prevent sepsis and multi-organ dysfunction. Inadvertent bladder injuries are common with lower-midline incisions. However, give good results when repaired suitably.
CONCLUSIONS: The rationale behind this report is to explicate the complexity and hurdles in the surgical management of rectal foreign bodies causing impalement injury.
摘要：
■由于异物穿刺而导致的直肠穿孔在实践中并不常见。意外或故意的异物插入对外科医生构成了诊断挑战，并将其置于要求成功提取的条件下。
方法：我们报告了一例60岁男性，据称有意外异物插入直肠的病史。射线照片显示线性金属异物，末端弯曲。直肠造影计算机断层扫描（CT）显示造影剂外渗，表明上直肠前壁穿孔。患者被紧急采取探查和异物取出。术中,膀胱无意中受伤。除膀胱修复外，还进行了肠切开术和乙状结肠造口术的初次修复。患者COVID-19检测呈阳性。在重症监护病房观察患者两天。术后除了进行二次闭合的中线腹部伤口间隙外，术后时间并不明显。患者使用原位导尿管出院。患者随访膀胱尿道图正常，造口功能良好。两个月后造口闭合顺利。
■需要全面的病史和临床检查，直肠异物患者应高度怀疑穿孔，应及时适当管理，以预防败血症和多器官功能障碍。意外的膀胱损伤在下中线切口中很常见。然而,给予良好的效果时，适当修复。
结论：本报告的基本原理是阐明直肠异物导致穿刺损伤的外科处理的复杂性和障碍。
方法：我们报告了一例60岁男性，据称有意外异物插入直肠的病史。射线照片显示线性金属异物，末端弯曲。直肠造影计算机断层扫描（CT）显示造影剂外渗，表明上直肠前壁穿孔。患者被紧急采取探查和异物取出。术中,膀胱无意中受伤。除膀胱修复外，还进行了肠切开术和乙状结肠造口术的初次修复。患者COVID-19检测呈阳性。在重症监护病房观察患者两天。术后除了进行二次闭合的中线腹部伤口间隙外，术后时间并不明显。患者使用原位导尿管出院。患者随访膀胱尿道图正常，造口功能良好。两个月后造口闭合顺利。
■需要全面的病史和临床检查，直肠异物患者应高度怀疑穿孔，应及时适当管理，以预防败血症和多器官功能障碍。意外的膀胱损伤在下中线切口中很常见。然而,给予良好的效果时，适当修复。
结论：本报告的基本原理是阐明直肠异物导致穿刺损伤的外科处理的复杂性和障碍。
