Anorectal avulsion: an exceptional rectal trauma
© Ibn majdoub Hassani et al.; licensee BioMed Central Ltd. 2013
Received: 13 April 2013
Accepted: 15 September 2013
Published: 7 October 2013
Anorectal avulsion is an exceptional rectal trauma in which the anus and sphincter no longer join the perineum and are pulled upward. As a result, they ventrally follow levator ani muscles. We present a rare case of a 29-years old patient who was admitted in a pelvic trauma context; presenting a complete complex anorectal avulsion. The treatment included a primary repair of the rectum and a diverting colostomy so as to prevent sepsis. Closure of the protective sigmoidostomy was performed seven months after the accident and the evolution was marked by an anal stenosis requiring iterative dilatations.
KeywordsAnorectal avulsion Rectal trauma Surgical management
Anorectal avulsion is an exceptional rectal trauma. In this kind of lesions, the anus and sphincter no longer join the perineum and are pulled upward. They are in addition ventrally following levator ani muscles. The management of this kind of lesions remains a matter of great debate. Early repair of the rectum, diverting colostomy, wound debridement, distal rectal wash-out are the most important procedures that help prevent sepsis. In addition, the colostomy closure can only be performed after pelvic rehabilitation in order to prevent transitory incontinence.
Reported cases of anorectal avulsion
Management of the anorectal avulsion
Mathieson, A. J et al.
Rupture of the posterior urethra and avulsion of the rectum and anus as a complication of fracture of the pelvis
Primary repair + presacral drainage + sigmoid loop colostomy
Sharma D. et al
Anorectal avulsion: an unusual rectal injury
Primary repair + presacral drainage + sigmoid loop colostomy
Terrosu G. et al
Anal avulsion caused by abdominal crush injury
Anal reimplantation + pelvic drainage tubes + loop transverse colostomy
Rispoli C. et al.
Anorectal avulsion: Management of a rare rectal trauma
Direct suture not possible sigmoid loop colostomy + presacral drainage + anoperineal reparation 10 weeks later
R. M. Gomesa et al
Anorectal avulsion: report of a rare case of rectal injury
diverting sigmoid loop colostomy (primary repair not possible)
Written informed consent was obtained from the patient for publication of this Case report and any accompanying images.
School of Medicine And Pharmacy of Fez, Sidi Mohammed Ben Abdellah University Department of Surgery, University hospital HASSAN II, BP: 1893; Km2.200, Route de Sidi Hrazem; FEZ 30000, MOROCCO.
The authors would like to thank the patient for his written consent and permission to present this case report. They would also like to thank Miss Ibn Majdoub Hassani Soukaina (Master : Multilingual Specialized Translation, Faculty of Arts and Humanities Sais-Fez /Sidi Mohamed Ben Abdellah University) for her help in editing and correcting this manuscript.
- Cintron JR: Colon and rectum trauma.http://www.fascrs.org/physicians/education/core_subjects/2006/colon_rectal_trauma/,
- Mathieson AJM, Mann TS: Rupture of the posterior urethra and avulsion of the rectum and anus as a complication of fracture of the pelvis. Brit J Surg. 1965, 52: 309-10.1002/bjs.1800520416.View ArticlePubMedGoogle Scholar
- Sharma D, Rahman H, Mandloi KC, Saxena A, Raina VK, Kapoor JP: Anorectal avulsion: an unusual rectal injury. Digestive Surg. 2000, 17: 193-194. PubMed: 10781991. 10.1159/000018831View ArticleGoogle Scholar
- Terrosu G, Rossetto A, Kocjancic E, Rossitti P, Bresadola V: Anal avulsion caused by abdominal crush injury. Tech in Coloproctology. 2011, 15: 465-468. [PubMed: 21556880]. 10.1007/s10151-011-0680-xView ArticleGoogle Scholar
- Rispoli C, Andreuccetti J, Iannone L: Anorectal avulsion: management of a rare rectal trauma. Int J Surg Case Rep. 2012, 3: 319-321. 10.1016/j.ijscr.2012.04.001.PubMed CentralView ArticlePubMedGoogle Scholar
- Gomesa RM, Kudchadkara J, Araujob E, Gundawarc T: Anorectal avulsion: report of a rare case of rectal injury, letter to the editor. Ann Gastroenterology. 2013, 26: 1.Google Scholar
- Velmahos GC, Gomez H, Falabella A, Demetriades D: Operative management of civilian rectal gunshot wounds: simpler is better. World J Surg. 2000, 24 (1): 114-118. PubMed: 10594214. 10.1007/s002689910021View ArticlePubMedGoogle Scholar
- Cleary RK, Pomerantz RA, Lampman RM: Colon and rectal injuries. Dis Colon and Rectum. 2006, 49 (8): 1203-1222. 10.1007/s10350-006-0620-y. PubMed: 16858663View ArticleGoogle Scholar
- Navsaria PH, Edu S, Nicol AJ: Civilian extraperitoneal rectal gunshot wounds: surgical management made simpler. World J Surg. 2007, 31 (6): 1345-1351. 10.1007/s00268-007-9027-1. PubMed: 17457641View ArticlePubMedGoogle Scholar
- Burch MD JM, Feliciano MD DV, Mattox MD KL: Colostomy and drainage for civilian rectal injuries: is that all?. Ann Surg. 1989, 209 (5): 600-610. 10.1097/00000658-198905000-00013. discussion 610-1View ArticleGoogle Scholar
- Gonzalez RP, Falimirski ME, Holevar MR: The role of presacral drainage in the management of penetrating rectal injuries. J Trauma. 1998, 45 (4): 656-661. 10.1097/00005373-199810000-00002. PubMed: 9783600View ArticlePubMedGoogle Scholar
- Armstrong RG, Schmitt HJ, Patterson LT: Combat wounds of the extraperitoneal rectum. Surgery. 1973, 74: 570-574. PubMed: 4729222PubMedGoogle Scholar
- Gonzalez RP, Phelan H, Hassan M, Ellis CN, Rodning CB: Is fecal diversion necessary for nondestructive penetrating extraperitoneal rectal injuries ?. J Trauma. 2006, 61 (4): 815-819. 10.1097/01.ta.0000239497.96387.9d.View ArticlePubMedGoogle Scholar
- Burch JM, Feliciano DV, Mattox KL: Colostomy and drainage for civilian rectal injuries: is that all?. Ann Surg. 1989, 209 (5): 600-610. 10.1097/00000658-198905000-00013.PubMed CentralView ArticlePubMedGoogle Scholar
- Ivatury RR, Licata J, Gunduz Y, Rao P, Stahl WM: Management options in penetrating rectal injuries. Am Surg. 1991, 57 (1): 50-55.PubMedGoogle Scholar
This article is published under license to BioMed Central Ltd. This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.