%0 Journal Article
%T Surgeon-performed sonographic findings in a traumatic trans-anal rectal perforation
%A Fikri M Abu-Zidan
%A Mohamed I Abusharia
%A Katharina Kessler
%J World Journal of Emergency Surgery
%D 2011
%I BioMed Central
%R 10.1186/1749-7922-6-26
%X Rectal injuries are uncommon. They are mainly caused by penetrating trauma. Early diagnosis and active management of trans-anal rectal injuries is essential for a favorable outcome [1,2]. Intraperitoneal rectal injuries will cause peritonitis, sepsis and even death if not detected early. Intraperitoneal free air (IFA) is usually diagnosed by an erect Chest X-ray [2]. If the erect chest X-ray was normal, then an abdominal CT scan is recommended. Point-of-care ultrasound has been recently used to detect IFA [3,4]. Hereby, we report an unusual case of trans-anal rectal injury in which point-of-care ultrasound was of a great help for an early diagnosis.A 45-year-old male presented to the Emergency Department complaining of lower abdominal pain and dysuria of two days duration. His blood pressure was 120/80 mmHg, his pulse was 107 beat per minute and his temperature was 36.8¡ãC. Abdominal examination revealed tenderness and guarding in the lower abdomen. Surgeon-performed portable point-of-care ultrasound as an extension of the abdominal examination was done immediately and revealed an inflamed omentum with hypoechoic stranding in the right upper quadrant (Figure 1A), thickened non compressible small bowel (Figure 1B), and free fluid in the pelvis. A transverse abdominal section of the right upper quadrant showed free intraperitoneal air (Figure 2). Rectal examination revealed a large longitudinal rectal tear 8 cm from the anal verge with an inflamed floppy mucosa. The patient admitted that he has inserted a glass bottle through his anus two days before, which was associated with sudden lower abdominal pain and a small amount of rectal bleeding. Erect chest X-ray confirmed the presence of air under the diaphragm (Figure 3). C-reactive protein was 418 mg/L (Normal less than 0.7 mg/L), serum creatinine was 139 micromol/L (normal less than 107 micromol/l) and white blood cell count was 13.8 ¡Á 109/L. Arterial blood gas has shown an arterial oxygen tension of 50 mmHg on normal
%K Rectal trauma
%K ultrasound
%K free intraperitoneal air
%U http://www.wjes.org/content/6/1/26