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

Area of Science:

• Urology
• Trauma Surgery

Background:

• Rectal impalement injuries involving bladder perforation are uncommon.
• These injuries are associated with significant postoperative morbidity.
• Early and accurate diagnosis is essential for optimal patient outcomes.

Purpose of the Study:

• To enhance awareness of rectal impalement injuries complicated by bladder perforation.
• To underscore the importance of comprehensive clinical examination and diagnostic investigations.
• To guide effective patient management strategies.

Main Methods:

• Retrospective review of three patients treated at University Hospital Hassan II.
• Analysis of symptoms, management, and follow-up data.
• Systematic review and analysis of 14 previously reported cases.

Main Results:

• Only one patient presented with overt urologic symptoms; diagnosis in others relied on rectal examination and imaging.
• Retrograde uroscanner confirmed bladder perforation in 71.4% of reviewed cases.
• Fecal and urine diversion were primary treatment modalities; no postoperative complications were reported in the current series.

Conclusions:

• A high index of clinical suspicion is paramount for diagnosing bladder perforation in rectal impalement.
• Meticulous preoperative assessment, including advanced imaging, is critical for successful management.
• Effective management involves prompt diagnosis and appropriate surgical diversion.