Laparoscopic repair of hydrostatic rectal injury. Case report and literature review.

Abstract

Introduction: Hydrostatic rectal injuries (HRI) occur when a pressurized fluid enters through the anus, overcoming the resistance of the rectal wall causing lesions of varied severity. 16 cases of rectal HRI were found in bibliography. The objective of this report is to present a case of HRI with rectal and sigmoid blow out managed laparoscopically.

Case report: 19-year-old woman, brought to our hospital with abdominal pain and rectal bleeding after falling down backwards from a jet ski. Physical examination revealed peritoneal signs and blood in the rectum. Ultrasound, rectosigmoidoscopy and diagnostic laparoscopy were performed, showing a tear in the anterior wall of intra and extraperitoneal rectum. Primary suture and double barrel colostomy were performed.

Conclusion: A case of intra and extraperitoneal rectal trauma of infrequent etiology is presented, managed entirely laparoscopically. Clinical presumption is highly important in patients with this mechanism of injury, as well as proctologic examination and proctosigmoidoscopy. Management does not differ from other etiologies of colorectal trauma, and laparoscopy can be used.