Abstract text (incl. references and figure legends)
A motorcyclist presented to our trauma unit after colliding with a car and flung. He sustained an open book pelvic fracture as well as right scrotal hematoma and laceration. After stablisation, he underwent open reduction and internal fixation of the pelvic fracture primary closure of the scrotal laceration on day 3 of admission. 2 days later, he was found to have per-rectal bleeding.
He was febrile and tachycardic. On per-rectal examination, there was an mucosal defect suspicious for an ano-rectal laceration at the superior aspect of the anal canal. Interval computed tomography scan revealed new air-fluid levels within the scrotal sac and extensive subcutaneous emphysema involving the bilateral inguinal regions. This was concerning for a delayed anoectal perforation with resultant pelvic sepsis.
He underwent wound debridement of the scrotal wound and sigmoid colostomy creation. There was a full thickness 3cm long anorectal laceration communicating with the scrotum with large amounts of clots. He had another surgery one week later for repeat pelvic and scrotal wound debridement due to wound infection. He did not require removal of the implants. He completed a 6 week course of antibiotics whilst undergoing aggressive rehabilitation.
He underwent closure of his stoma once the anorectal laceration and scrotal wounds have completely healed.
Our postulation is that a micro-tear in the anal mucosa was likely present initially which was converted to a full thickeness perforation due to increased pressure and a mass effect caused by expansion of the scrotal hematoma. This illustrates a unique case of a delayed anorectal perforation with involvement of the scrotum resulting from a complex pelvic trauma.
References
1. Trauma to the pelvis:Injuries to the Rectum and Genitourinary Organs.Curr Trauma Rep(2015)1:8-15
2. Management of anorectal wounds.J Indain Med Assoc 2021;119(5):89-94
3. Care of the patient with anorectal trauma.Clin Colon Rectal Surg 2012;25:210–213
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