Anterior rectal wall perforation from accidental maize stem injury: a rare case and management insight

Colorectal injuries are rare, with a reported incidence of 1%-3% in trauma cases, predominantly due to penetrating trauma. They may arise from pelvic trauma, ingestion, or insertion of foreign objects, often for sexual gratification, self-treatment, or accidental entry. Such injuries are frequently underreported due to embarrassment or denial, leading to delayed diagnoses. Despite their rarity, prompt diagnosis and aggressive treatment are critical to achieving favorable outcomes.

A 53-year-old male from Dhankuta, Nepal, presented with anal trauma caused by a maize stem during fieldwork. He experienced continuous perineal pain and mild bleeding shortly after the injury but had no fever, vomiting, or urinary retention. Examination revealed stable vitals, a soft and non-tender abdomen, and lax anal sphincter tone with tenderness and dark blood on digital rectal examination. Imaging showed free gas under the diaphragm, and a computed tomography scan revealed a rectal wall perforation approximately 6-7 cm from the anal verge, with air tracking to the rectovesical pouch. An exploratory laparotomy confirmed a 2 × 2 cm anterior rectal wall perforation, which was repaired with peritoneal lavage and a sigmoid loop colostomy.

Rectal injuries, though rare, often result from penetrating trauma, including foreign body insertion. Studies highlight that males are more commonly affected, and injuries vary between intraperitoneal and extraperitoneal types, influencing management strategies. Early surgical intervention, including fecal diversion, significantly reduces morbidity and mortality, particularly in high-risk cases.

This is the first case of corn stalk injury and it highlights the importance of timely surgical intervention in such cases.