Penetrating injury of rectum caused by fall in shower.

A 15-year-old girl slipped at home while having a shower and fell through a glass panel. On admission to Craigavon Area Hospital, she was found to be shocked with a blood pressure of 100/60 mmHg but she improved quickly with intravenous fluids. There were large lacerations of both buttocks and it was thought that these were the cause of shock. She had multiple other lacerations. Her abdomen was soft and was not tender with no guarding or rebound. As she had eaten 2 hours previously, surgery was postponed for a further 2 hours. Just before surgery, she became profoundly shocked with a blood pressure of 80/50 mmHg, and said that she felt glass in her abdomen and vagina. Her abdomen was found to be rigid. She was resuscitated and then anaesthetized before operation by a surgeon and a gynaecologist. A small amount of blood was noted to be coming from her vagina. Two large pieces of glass were removed from her vagina and another piece was removed from her left buttock. Each piece of glass was removed very carefully and none of these pieces were found to be occluding a major blood vessel. At this stage it was felt that the glass had entered the peritoneal cavity. Palpation of the abdomen under general anaesthetic revealed a mass arising from the right iliac fossa. At laparotomy, a large amount of free blood and clot was encountered, and her blood pressure fell to an unrecordable level. After manual compression of her abdominal aorta and rapid transfusion she regained a blood pressure of 100/60 mmHg. Her abdomen was cleared of blood and a piece of glass measuring 5 cm in length was removed. This glass had lacerated the right common iliac vein, which was repaired. Perforations in the terminal ileum and bladder, and a laceration involving the right broad ligament,