Anorectal avulsion: report of a rare case of rectal injury

Blunt rectal injuries are very uncommon forming 4-11% of all rectal injuries and the rest are accounted for by penetrating rectal trauma [1]. Anorectal avulsion is a rare rectal injury [2]. A 30-year-old male admitted after a motorcycle accident with history of being partly runover by a vehicle over the right side of his pelvis with no history of impalement was found to have right superior and inferior pubic ramus and right T11 transverse process fractures with no chest, abdominal or bladder injuries. He had soft tissue injuries with a large hematoma over his right lateral thigh treated with aspirations. On resurvey in 72 h an inspection of his anus revealed patulous opening with bleeding and feculent material. Digital examination revealed complete avulsion of the anorectal complex from the anal opening at the skin lying above at a distance of around 12 cm with a large cavity below including both ischiorectal fossae (Fig. 1A, 1B). The stump was also separated from the lower sacrum and coccyx (Fig. 1B, 2B). Both the levator ani were exposed but intact with the anorectum surrounded by the anal sphincter and puborectal muscle which appeared intact but with obvious loss of attachments and no tone (Fig. 2A, 2B). No direct suture was possible because of the retracted stump and infected cavity. A diverting sigmoid loop colostomy was performed and the anorectal stump was intubated with distal loop washouts, debridements and dressing changes. Right thigh hematoma was infected after a few weeks and drained revealing communication with the perineal cavity through the posterior thigh compartment. Ischio-rectal and thigh wound healing by secondary intention was awaited. Patient was transferred after 4 weeks to another hospital because of financial constraints and lost to follow up. Digital exams still revealed patulous distal anorectal stump with no tone before LETTER TO THE EDITOR