We present an extremely rare case of a 27-year-old Syrian woman who sustained an ischiorectal
laceration following a motorcycle accident. The mechanism of injury remains uncertain,
as language barriers prevented clarification of whether a sharp object caused the
laceration or if it occurred from blunt force trauma during the fall. ([Fig. 1])
Fig. 1 The black arrow indicates a preserved rectum, while the white arrow indicates an
ischiorectal laceration.
On admission, the patient's vital signs were stable, and an abdominal examination
yielded no significant findings. In the lithotomy position, a 10 cm deep laceration
in the ischiorectal fossa was identified, with no involvement of the external sphincters.
Computed tomography (CT) showed edema in the pelvic soft tissues and minimal air densities
beneath the skin. ([Fig. 2]) Despite these findings, no hematuria was noted, and the patient was treated with
debridement, loop colostomy, and suturing. ([Fig. 3]) The patient was discharged on the 8th postoperative day uneventfully.
Fig. 2 The red arrow indicates millimetric air density.
Fig. 3 View after repair.
Literature highlights that early and thorough evaluation of anorectal trauma is essential
to prevent complications such as sepsis. As noted by Herzig et al., digital rectal
examination and CT scanning are pivotal in the assessment of anorectal injuries, while
sigmoidoscopy should be approached with caution due to the risk of exacerbating injuries.[1] In line with Hassani et al., our case underlines the importance of pelvic debridement
and loop colostomy in preventing septic complications.[2] Furthermore, failure to detect injuries in the upper rectum or sigmoid colon can
lead to fatal outcomes, as demonstrated in the case report by Katano et al.[3]
In conclusion, this case emphasizes the necessity of a high index of suspicion and
prompt intervention in cases of anorectal trauma, particularly in instances where
the mechanism of injury is unclear. Further research is warranted to better understand
the management of rare injuries such as ischiorectal lacerations and to optimize patient
outcomes.
