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Journal of Emergencies, Trauma, and Shock I 8:3 I Jul - Sep 2015
Anal-perineal impalements are infrequent and potentially life-
threatening injuries. Mortality rates are related to the severity of
the trauma. Treatment requires a wide colo-proctological surgical
expertise. A similar nonfatal case involving rectum, bladder,
mesentery, liver, and right lung was recently published in 2012.[2]
Most of the other reported cases are case series of pediatric
patients victim of sexual abuse.[3] The surgical treatment of anal-
perineal impalement can be problematic when serious vascular
lesions have been caused, or multiple organs are involved;
besides, uncomfortable sequelae such as urinary incontinence,
anal sphincter dysfunction, and colonic diversion are frequent.[4]
Our case highlights how complex the management of an anal
impalement can be when the pelvis, abdomen, and thorax are
involved simultaneously. For a correct management of such
kind of lesions, a multidisciplinary approach to deal with the
various injuries is needed, and the penetrating object must not
be displaced until the surgical procedure has not begun. Novel
approaches have been suggested, for example, in a recent case,
authors report the successful implementation of a laparoscopic
approach for a pediatric impalement injury.[5]
Fausto Fama’, Alessandra Villari,
Dario Lo Presti, Maria Gioffre’-Florio
Department of Human Pathology “Gaetano Barresi”,
University Hospital of Messina, 98125 Messina, Italy
E-mail: famafausto@yahoo.it
REFERENCES
1. Orr CJ, Clark MA, Hawley DA, Pless JE, Tate LR, Fardal PM. Fatal anorectal
injuries: A series of four cases. J Forensic Sci 1995;40:219-21.
2. Ho LC, El Shafei H, Barr J, Al Kari B, Aly EH. Rectal impalement
injury through the pelvis, abdomen and thorax. Ann R Coll Surg Engl
2012;94:e201-3.
3. Sugar NF, Feldman KW. Perineal impalements in children: Distinguishing
accident from abuse. Pediatr Emerg Care 2007;23:605-16.
4. Papadopoulos VN, Michalopoulos A, Apostolidis S, Paramythiotis D,
Ioannidis A, Mekras A, et al. Surgical management of colorectal injuries:
Colostomy or primary repair? Tech Coloproctol 2011;15:S63-6.
5. Hammond PJ, Jackson MJ, Jaffray B. Laparoscopic primary repair of a
pediatric transanal impalement injury: a case report. J Laparoendosc Adv
Surg Tech A 2007;17:813-4.
A fatal anal impalement
Dear Editor,
Anal impalements are infrequent injuries, and generally involve
only gastrointestinal, urinary or genital pelvic structures. They
are rarely fatal. Only one previous fatal case was reported in the
literature in 1995.[1] We report a rare case of fatal impalement,
to our knowledge, the second one to be ever described in the
literature.
A 63-year-old man was admitted to the emergency department
after an accident occurred in his garden. He presented a trans-
anal impalement by a metallic rod [Figure 1] and a complex
wound in the left-side thoracic wall [Figure 2]. On arrival,
consciousness was preserved despite the low blood pressure.
The only immediate therapy started was uid resuscitation.
Unfortunately, the patient died for a severe hemorrhagic shock.
Letters to Editor
Figure 1: Entrance penetrating wound
Figure 2: Exit penetrating wound with a severe lesion in the left-
side sub-clavicular region
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DOI:
10.4103/0974-2700.161660
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