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Severe perineal injury

A 23-year-old man was admitted with severe perineal trauma after falling onto a full cocktail glass while playing a sport simulation on his game console. He sustained a 5cm vertical laceration lateral to the anal verge on the left side, and when he emptied his bowels, he passed 2 l of fresh blood. He was tachycardic and hypotensive with lower abdominal tenderness. Digital examination per rectum revealed fresh blood. The patient was resuscitated and a pelvic X-ray was performed to exclude a foreign body before surgical exploration. This confirmed the presence of a shard of glass within the perineal wound (Fig. 1a). An examination under anaesthetic was performed using a sterile cut-proof glove (Kevlar ; Fig. 1b) to enable examination of the laceration while avoiding the risk of injury. The wound was 10 cm deep, extending towards the pelvis. The glass was found and removed. Examination of the rectum revealed a 4-cm laceration in the posterior rectal wall communicating with the open wound. This was closed, leaving the perineal wound open. A laparotomy was performed. The peritoneal cavity was found to be full of blood resulting from a laceration through the pelvic peritoneum. This was controlled by sutures. A double-barrelled defunctioning colostomy was fashioned to protect the rectal repair. Postoperatively, he made an unremarkable recovery.