PENETRATING RECTAL TRAUMA WITH MULTIPLE PSEUDOANEURYSMS AND LUMBOSACRAL PLEXUS INJURY: A RARE CASE REPORT balaji.jay73@gmail.com

 

PENETRATING RECTAL TRAUMA WITH MULTIPLE PSEUDOANEURYSMS AND LUMBOSACRAL PLEXUS INJURY: A RARE CASE REPORT

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United Kingdom

Poster with Discussion

Rectal trauma is uncommon, accounting for 1–3% of civilian injuries, and is associated with significant morbidity. Traumatic pseudoaneurysm as a complication of penetrating rectal injury is extremely rare, and neurological injury has not been previously described. We report a case of penetrating rectal trauma complicated by multiple pseudoaneurysms and lumbosacral plexus involvement.

A male in his 60s presented following penetrating rectal trauma from a foreign body. He was managed in a district general hospital with serial imaging, surgical intervention, and interventional radiology input. Case details, imaging, interventions, and outcomes were retrospectively analysed.

Initial CT revealed a rectal perforation with pelvic sepsis. The patient underwent laparoscopic sigmoid loop colostomy, followed by laparotomy and Hartmann’s procedure after recurrent bleeding. Despite multiple surgical explorations, haemorrhage persisted. CT angiography and fluoroscopy identified pseudoaneurysms of the middle rectal and superior gluteal arteries, both successfully treated with coil embolisation. During admission, he developed right leg weakness with foot drop, attributed to lumbosacral plexus compression from pelvic collections. He required prolonged inpatient care with multiple drainage procedures and rehabilitation. Quality-of-life assessment (SF-36) demonstrated marked functional impairment across physical, emotional, and social domains.

This case highlights the diagnostic and therapeutic challenges of traumatic pseudoaneurysm following rectal injury. Early CT angiography is vital in unstable patients to identify occult vascular injuries. Multidisciplinary input, particularly interventional radiology, is essential. The associated neurological complication underlines the need for vigilance in managing complex pelvic trauma.