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.
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.
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