Blunt Trauma to the Rectum and Urethra After a Fall on the Ski Trail
A 17-year-old man sustained a snow-bike accident and was taken to the hospital within 45 minutes because of increasing lower abdominal pain and macrohematuria. Physical examination revealed tenderness over the coccyx and the symphysis pubis, as well as reduced anal sphincter tone with a small amount of blood on the examiner’s gloved finger. Emergency FAST sonography showed free fluid in the rectovesical pouch. Abdominal computed tomography revealed a perivesicular and pararectal hematoma (Figure). A semicircular urethral lesion was urethroscopically splinted, and a mucosal tear in the anterior wall of the rectum above the anorectal junction was rectoscopically sutured. The injuries were attributed to direct blunt trauma in the setting of an anatomical variant of a coccygeal bone pointing ventrally and far anteriorward. Blunt rectal trauma without accompanying bony trauma of the pelvic ring is exceedingly rare. More than 90% of cases involve tears of the serosa. Our patient had an uncomplicated course and was discharged home six days after surgery.
Dr. med. Jonas Brunner, Dr. med. Michael Stickel, Notfallzentrum Luzerner Kantonsspital, Schweiz, email@example.com
Dr. med. Hartwig Fenner, Vizeralchirurgie, Luzerner Kantonsspital, Schweiz,
Conflict of interest statement: The authors state that no conflict of interest exists.
Cite this as: Brunner J, Stickel M, Fenner H: Blunt trauma to the rectum and urethra after a fall on the ski trail. Dtsch Arztebl Int 2018; 115: 326.
Translated from the original German by Ethan Taub, M.D.