title: Rectal impalement with bladder perforation: A review from a single institution.
abstract: BACKGROUND
  Impalement injuries of the rectum with bladder perforation have been rarely reported. Such lesions have been associated with increased postoperative morbidity. A well-conducted preoperative evaluation of the lesions tends to prevent such complications.
  
  
  OBJECTIVE
  To increase awareness about patients with rectal impalement that involve bladder injuries and to examine the significance of thorough clinical examination and complementary investigation for these patients' management.
  
  
  METHODS
  Retrospectively, we identified three patients with rectal impalement and bladder perforation treated in University Hospital Hassan II, Fez, Morocco. We recorded the symptoms, subsequent management, and further follow-up for each patient. All available variables of published cases were reviewed and analyzed.
  
  
  RESULTS
  Evident urologic symptoms were present in only one patient. Bladder perforation was suspected in two other patients on the basis of anterior rectal perforation in digital exam. Retrograde uroscanner could definitely confirm the diagnosis of bladder perforation. Fecal and urine diversion was the basis of the treatment. No postoperative complications were noted. We have reviewed 14 previous reports. They are presented mainly with urine drainage through the rectum. Radiologic investigation (retrograde cystography and retrograde uroscanner) confirmed bladder perforation in 10 patients (71.4%). Unnecessary laparotomy was performed in six patients (42.8%). Fecal diversion and urinary bladder decompression using urethral catheter were the most performed procedures in bladder perforation [6/14 patients (42.8%)]. No specific postoperative complications were reported.
  
  
  CONCLUSIONS
  A high index of clinical suspicion is required to make the diagnosis of bladder perforation while assessing patients presenting with rectal impalement. Meticulous preoperative assessment is the clue of successful management.
authors: Department of General Surgery, University Hospital Hassan II, Fez, Morocco.
authors: Ei Bachir
authors: EB
authors: Benjelloun
authors: Youness
authors: Y
authors: Ahallal
authors: Khalid
authors: K
authors: Khatala
authors: Tarik
authors: T
authors: Souiki
authors: Iman
authors: I
authors: Kamaoui
authors: Khalid Ati
authors: KA
authors: Taleb
keywords: Bladder perforation; laparotomy; rectal impalement; retrograde-uroscanner