Impalement Injuries of the Rectum

IT iS proposed to present a case of impalement injury of the rectum and to review briefly the diagnosis, prognosis, and treatment of such cases. From a study of the literature, it appears that these injuries are not very common. One of the earliest reviews of this subject was in 1896, when Van Hook of Chicago analysed fifty-eight cases, two of which were his own. Stiassney and Tillman added further cases in 1905, but the most extensive early survey was done by Habhegger of Wisconsin in 1912, when he analysed one hundred and seventy-five injuries of this type. Of this total, there was penetration of the peritoneal cavity in seventy. Spencer (1912) and Roques (1931) recorded further cases. In 1938 Hambly reported a case in which a steel tube penetrated to a distance of eighteen and a half inches. His patient was a boy aged fifteen years, and the rod, after penetrating the perineum, entered the peritoneal cavity, passed through the transverse mesocolon and small intestine, coming, to lie under the skin of the chest wall, in front of the sixth and seventh costal cartilages. Other cases have been published by Conway Crvmble's case the handle of a hayfork penetrated through the ischio-rectal fossa, perforated the levator ani, and left the pelvic cavity through the great sciatic notch without damaging any important structures. O;'Regan (1947), in an excellent review of the subject, was able to account for two hundred reported cases and he, himself, added four more. Thomas (1953) recorded three further cases, two of whom had peritoneal involvement and recovered following operation. The following case is interesting in that a metal tube not only penetrated the perineum and peritoneal cavity, but also passed through the left dome of the diaphragm into the left pleural cavity. Having examined the literature on the subject, I can find reference to one similar case only-that reported by Roques (1931) in France. Unfortunately, the thesis in which this case was reported is unobtainable. A boy aged sixteen years was admitted to the Downe Hospital, Downpatrick, on 8th May, 1953. A history was given that one hour previously, while jumping over a tubular metal crossbar (in. diameter), he accidentally landed on it. The crossbar collapsed, and part of it, turning into the vertical position, penetrated his perineum. The boy's father removed the tube and his doctor had him transferred to this hospital. On admission, the …