Ağaçtan düşme sonrası perine ve sfinkter yaralanması olmadan penetran rektum ve mesane yaralanması

Travmatik rektum yaralanmaları nadir görülen, yüksek morbidite ve mortalite oranları ile seyredebilen bir yaralanma türüdür. Tedavi yaklaşımları deneyimlere göre değişebilmektedir. Otoerotizm veya cinsel saldırı amaçlı oluşan yaralanmalar haricinde genellikle tabloya minimal de olsa perine ve/veya sfinkter yaralanmaları eşlik etmektedir. Bu yazıda, yüksekten bir ağaç dalı üzerine düşme sonrası oluşan, perine ve sfinkter yaralanmasının eşlik etmediği ve klinik şüphe üzerine yapılan rektal tuşe ile tanı konulan penetran rektum yaralanması olgusunu sunduk ve bu olgu eşliğinde rektum yaralanmalarının tanı algoritmasını kısaca gözden geçirmeyi amaçladık.

Penetrating rectum and bladder injury without perineal and sphincter damage after falling down from tree

Even though traumatic rectal injuries are rare, they have increased morbidity and mortality. Treatment options may vary based on the experience of the surgeon experiences. Among tramatic rectum injuries, perineum or sphincter injuries are observed, even though their number is small in cases other than those caused by autoeroticism and sexual abuse. In this paper, we present an impalement rectal injury case without perineum and sphincter damage. Since injury was diagnosed by digital rectal examination, we focused the discussion of the diagnosis options on rectal injuries.

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1) Grasbeger RC, Hirsc EF. Rectal trauma. A retrospective analysis and guidelines for therapy. Am J Surg 1983; 145:795-9
2) Gonzalez RP, Falimirski ME, Holevar MR. The role of presacral drainage in the management of penetrating rectal injuries. J Trauma 1998; 45:656-61
3) Shatnawi NJ, Bani-Hani KE. Management of civilian extraperitoneal rectal injuries. Asian J Surg 2006; 29:11-6
4) Burch JM. Injury to the colon and rectum. In: Mattox KL, Felicianco DV, Moore EE, eds. Trauma. New York: McGraw-Hill, 1999:76
5) Clarke DL, Buccimazza I, Anderson FA, Thomson SR. Colorectal foreign bodies. Colorectal Dis 2005; 7:98-103
6) El-Ashaal YI, Al-Olama AK, Abu-Zidan FM. Trans-anal rectal injuries. Singapore Med J 2008; 49:54-6
7) Moncure M, Konie JA, Kretzer AB, Dipasco PJ, Braxton CC. Survival following rectal impalement through the pelvic, abdominal, and thoracic cavities: A case report. Case Report Med 2009; 2009:361829
8) Falcone RE, Carey LC. Colorectal trauma. Surg Clin North Am. 1988; 68:1307-18
9) Gonzalez RP, Turk B. Surgical options in colorectal injuries. Scand J Surg 2002; 91:87-91
10) Haas PA, Fox TA Jr. Civilian injuries of the rectum and anus. Dis Colon Rectum 1979; 22:17-23
11) Morken JJ, Kraatz JJ, Balcos EG, Hill MJ, Ney AL, West MA, Van Camp JM, Zera RT, Jacobs DM, Odland MD, Rodriquez JL. Civilian rectal trauma: a changing perspective. Surgery 1999; 126:698-700
12) Berne JD, Velmahos GC, Chan LS, Asensio JA, Demetriades D. The high morbidity of colostomy closure after trauma: further support for he primary repair of colon injuries. Surgery 1998; 123:157-64
13) Zmora O, Mahajna A, Bar-Zakai B, Rosin D, Hershko D, Shabtai M, Krausz MM, Ayalon A. Colon and rectal surgery without mechanical bowel preparation: a andomized prospective trial. Ann Surg 2003; 237:363-7
14) Levy RD, Strauss P, Aladgem D, Degiannis E, Boffard KD, Saadia R. Extraperitoneal rectal injuries. J Trauma 1995; 38:273-7