Traumatic rectosigmoid injury with active bleeding

Case contributed by RMH Core Conditions

Presentation

Penetrating trauma to the perineum.

Patient Data

Age: 74
Gender: Male

Rectosigmoid bowel wall thickening with mural oedema and surrounding fat stranding noted.

Active contrast extravasation on arterial phase with contrast pooling on portovenous phase images consistent active bleeding at the rectosigmoid junction. Small amount of free fluid in the pelvis and left inferior paracolic gutter.

No pneumoperitoneum to suggest perforation. 

Conclusion:

  1. Findings are in keeping with rectosigmoid junction active bleeding.
  2. Rectosigmoid bowel wall thickening, consistent with direct trauma to rectum and distal sigmoid colon.

Case Discussion

Traumatic perineal injuries are rare. Less severe anorectal injuries (AAST grades ≤ II) can be typically managed with primary operative repair, whilst more severe anorectal injuries (AAST grades ≥ III) may require resection and anastomosis +/- diverting colostomy.

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Case Information

rID: 33578
Case created: 16th Jan 2015
Last edited: 10th Sep 2015
Inclusion in quiz mode: Included

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