COMPLEX PELVIC FRACTURES ASSOCIATED WITH ANORECTAL LESIONS

Traumatic lesions of the rectum, perineum and anus are rare but difficult to treat, requiring experience in terms of trauma and colorectal surgery. Case report and electronic search of the U.S. National Library of Medicine National Institutes of Health PubMed/MEDLINE, EMBASE, Google Scholar, ISI Web of Knowledge, to identify original articles and reviews about the subject. Case 1 - Male patient, 31 years old, victim of a car accident, transferred to our hospital from a lower level trauma center, with cranial, abdominal and extremity trauma (ISS = 29). On FAST there was free peritoneal fluid. The patient was transported to the operating room. Abdominal exploration revealed a grade IV laceration of the sigmoid colon and upper rectum, with diffuse fecaloid peritonitis and middle hemoperitoneum. Hartmann type colorectal resection was performed. Postoperative whole body Computed Tomography detailed the complex type C pelvic fracture, immobilized with an external fixator during initial surgical approach. The clinical evolution was favourable, the patient being referred to a lower level local center for rehabilitation. Case 2 - Male patient, 27 years old, bicyclist victim of a car accident, admitted to our hospital in emergency setting for right inguinal open wound with extension to anorectal region and pelvis-subperitoneal space, complex pelvic trauma and lower limb fractures (ISS = 29). The patient was transported to the operating room. Perineal packing was performed with external pelvic fixation and lower limb fractures reduction along with external fixation. The clinical evolution was favourable, the patient being referred to a lower level local center for continuation of the therapy. Significant injuries to the pelvic ring, most commonly the result of high energy trauma, carry with them high rates of both morbidity and mortality, and only prompt diagnosis and treatment are the key to success.