16-Year-Old Male Patient with Anorectal Trauma After Bicycle Accident

Case Summary

• 16-yr-old patient presents to the emergency department 5 d after a bike accident where he suffered an anorectal trauma.
• On physical exam, he had skin and the anoderm on the right side with damage of the anal canal with skin and fat tissue necrosis.
• Diverting colostomy and delayed surgical reconstruction were performed. Colostomy and mucous fistula were placed. Mucous fistula was irrigated.
• Necrotic tissue was resected.
• Partial reconstruction of the anatomy.
• 2 d after colostomy and anorectal reconstruction the patient developed a wound infection.
• Antibiotic therapy was changed, which improved the healing of the wound.
• 7 d after surgery, the patient presented with abdominal pain and vomiting.
• Abdominal X-ray showed signs of intestinal obstruction.
• Laparotomy was performed and a 180-degree twist of the descending colon below the abdominal wall was identified.
• Aponeurosis was tight, and the solid fecal stasis caused the twist. New proximal stoma was performed.
• 5 d after the laparotomy, the patient presented with abdominal pain.
• Ultrasound identified an abdominal abscess.
• Antibiotics were changed, and the infection improved.
• 6 wk after the first surgery exam showed 75% of the anal canal was damaged.

Takeaways

• Next steps would be to examine the anus under anesthesia to ensure that it is well healed and there is no stricture. Then the colostomy could be closed.
• Patients with trauma typically still have bowel control after reconstruction.