Anorretal trauma and blunt pelvic trauma

case report and literature review

Abstract

INTRODUCTION: Anorretal trauma is a complex pathology with multiple causes, such as penetrating injuries, blunt trauma and iatrogenic causes. Although conducted in the secondary assessment of the polytraumatized victim, it is of great importance due to the potential for progression to serious complications. Perineal lesions can affect the anorretal sphincter apparatus and the coloproctological system, due to anatomical and functional alterations, such as fecal incontinence. Case report: Male patient, 33 years old, admitted to the emergency unit due to multiple trauma due to a collision. During the evaluation, direct quadril dislocation was evidenced, associated with an extensive direct perineal laceration, with extension to the middle gluteal region, with anocutaneous detachment in 70% of the circumference and exposure of the internal anal sphincter. Opted for debridement and local cleaning, followed by separate composite suturing in two planes. A satisfactory evolution has been achieved, with infectious control and without the need for early reintervention. From a functional point of view, there is no definition of the sphincter sequelae due to the neurological quadro installed. Discuss: Dor pelvica, obstipação, tenesmo and bleeding remnants são queixas recounted in emergencies in their most diverse presentations. The patient must be submitted to primary assessment for hemodynamic stabilization and diagnosis of lesions that demand immediate addressing, and subsequently, anorhetal trauma may be better addressed. Regarding the management of extraperitoneal retinal trauma, primary raffia and diversion of intestinal transit can be attempted in cases of impossibility of access or in cases of rock raffia. Small perineal lesions can be addressed with primary repair, but extensive lesions generally require delayed sphincter reconstruction.