Hydrogen peroxide irrigation as an adjunct to digital rectal examination for detection of penetrating low rectal injuries

Rectal trauma carries significant morbidity, particularly if there is a delay in diagnosis. Digital rectal examination has a relatively low sensitivity. Proctoscopy and sigmoidoscopy are available but can be limited in situations with increased fecal burden or uncooperative patients. We suggest more sensitive bedside techniques are necessary to diagnose low rectal injury, and here present a case report to demonstrate proof of concept using hydrogen peroxide to directly visualize an injury.

Digital rectal examination was performed in a patient after multiple gunshot wounds and was negative for gross blood. Suspicion for low rectal injury remained high, and hydrogen peroxide was used to evaluate bullet trajectory. Approximately 25 mL of 3% hydrogen peroxide was instilled into the bullet tract.

Hydrogen peroxide evaluation of the bullet tract was performed in less than 1 min with minimal supplies and preparation. It revealed an extraperitoneal injury where the rectal examination had been falsely negative.

Hydrogen peroxide may be used to evaluate a suspected penetrating injury of the rectum. Considering the potential of this modality to diagnose injuries in a timely and reliable manner, additional investigation may be warranted.