Management of Penetrating Rectal Injuries in Children A Case Report

Ano-rectal trauma in a child is associated with significant physical and emotional morbidity. Except for an occasional straddle injury, child abuse or deviate sexual activity account for most rectal injuries in children. Traumatic injury to the rectum and large intestine can occur from a number of mechanisms: blunt from acute compression or deceleration; external penetrating, most commonly from projectiles orbladed weapons; or internal penetrating from foreign bodies introduced recreationally or iatrogenically. The importance of rapid diagnosis and intervention cannot be overstated. Less is known about the management of penetrating rectal injuries in children, which are often reported in conjunction with blunt injuries or colon injuries. Currently, there are no studies that directly address pediatric specificmanagement of penetrating rectal injuries. A 7-year-old boy was brought to our center about 1 hr after having fallen astraddle a sharp staff. The vital signs were stable and the abdomen was soft and nontender. Fresh blood was apparent on digital examination of the rectum, and a long anterior rectal perforation was found 9 centimeters above the anal verge. At laparotomy, no intraabdominal injuries were found except an anterior rectal perforation in about 4 cm diameter just above rectovesical pouch. A diverting sigmoid colostomy was constructed andanterior rectal repair was performed primarily. A follow up barium enema after 8 weeks revealed a normal rectum and the colostomy was closed.