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Complex Perineal Trauma with Anorectal Avulsion
Adelina Maria Cruceru1, Ionut Negoi2, Sorin Paun2
1Emergency Hospital of Bucharest, Bucharest, Romania.
Case Reports in Surgery
|November 29, 2016
Summary
This case report details a severe perineal impalement injury with anorectal avulsion and hemorrhagic shock. Prompt surgical intervention in a specialized center led to favorable outcomes and no long-term complications.
Area of Science:
- Trauma Surgery
- Colorectal Surgery
- Emergency Medicine
Background:
- Severe perineal impalement injuries are rare but associated with high morbidity and mortality.
- Anorectal avulsion and hemorrhagic shock present significant management challenges.
Purpose of the Study:
- To illustrate the management of a complex case of severe perineal impalement injury.
- To highlight the importance of specialized care in improving patient outcomes.
Main Methods:
- A 32-year-old male with perineal impalement, pelvic fracture, and anorectal avulsion presented with hemorrhagic shock.
- Initial management included resuscitation, surgical exploration, pelvic packing, and temporary colostomy.
- Subsequent emergency laparotomy identified and managed hemoperitoneum from a ruptured pelvic hematoma.
Main Results:
- The patient required multiple surgical interventions, including laparotomy and sigmoid colostomy.
- Initial resuscitation and surgical management controlled bleeding and stabilized the patient.
- The patient was discharged after 70 days with colostomy closure at four months, experiencing no long-term complications.
Conclusions:
- Aggressive management of severe perineal injuries is crucial for reducing mortality and morbidity.
- High-volume centers with expertise in trauma and colorectal surgery are essential for optimal patient outcomes.
- Timely and comprehensive care can lead to successful recovery and improved quality of life.