[Impalement injuries. A clinical case]

The authors present a case of penetrating injury of the extraperitoneal rectum, in a worker of 41. The treatment required a simple suture, because the conditions were favourable, such as simple lesions, without peritoneum contamination. Moreover, the authors propose a review of the literature, to single out the factors which influence mortality and mobility, as well as the most recent pathogenetic and therapeutic findings. Lesions caused by impalement are usually a difficult surgical problem. The mechanism of the injury, is usually a direct one, commonly diffused among workers. The entity of these lesions depends on the fall height, the penetrating object dimensions and the patient's weight. The diagnosis is based on anamnestic, clinical, radiological and endoscopic observations. The prognosis depends on several factors, such as: 1) the trauma extension and the presence of associated lesions; 2) the time elapsed between the trauma and the treatment influences the degree of bacterial contamination; 3) the patient's age and his physical conditions; 4) the assistance quality at the moment of the occurrence. The mortality, as far as complex lesions are concerned, is nowadays very high (50-75%).