RECTAL LACERATION FOLLOWING FISTING PRACTICE

Case Presentation A 33-year-old male, HIV-positive, sought emergency care for enterorrhagia and abdominal pain after engaging in fisting seven days before admission. He was hospitalized, underwent tests, and was treated with antibiotics while being observed, but he left the hospital after four days of treatment. He required readmission due to anal pain associated with bowel movements, though the bleeding complaint improved. Upon admission, there were no abnormalities in the abdominal physical exam. A proctological examination revealed a laceration in the right posterolateral region, extending 7 cm from the anal border. Abdominal CT scan showed irregular wall thickening in the middle and lower thirds of the rectum, with mesorectal fat densification and small adjacent gas foci. A flexible sigmoidoscopy was performed, revealing a deep transmural linear laceration starting at the pectinate line and extending about 8 cm cranially. The emergency department team recommended surgery: suturing the laceration, presacral drainage, and loop sigmoidostomy. The patient progressed well and was discharged on the seventh postoperative day.

Discussion The treatment of traumatic rectal injuries has evolved. Initially, it was based on injuries occurring during armed conflicts, such as landmine explosions in the Vietnam War. Traditionally, the treatment of extraperitoneal rectal injuries had four main pillars: intestinal diversion, presacral drainage, distal rectal lavage, and local repair. However, recent guidelines have abandoned presacral drainage due to higher rates of local infections, as well as distal rectal lavage, which has not shown proven benefits. Currently, despite controversy, ostomy is still recommended for patients with full-thickness extraperitoneal rectal lacerations, as it reduces the rate of infectious complications, even without affecting mortality. Surgical indications should consider each case and the risk-benefit ratio of the morbidity associated with ostomy. In the specific case described, the coloproctology team suggested conservative management, given the time since the trauma (15 days) and the lack of systemic repercussions, but the emergency team opted for surgical intervention.

Conclusion The practice of fisting is becoming increasingly popular, highlighting the need for updated management approaches for post-traumatic rectal injuries.

 

MissingLinkText

No conflict of interest has been declared by the author(s).

Publication History

Article published online:
25 April 2025