Importance of Early Detection and Management in Ischiorectal Laceration

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We present an extremely rare case of a 27-year-old Syrian woman who sustained an ischiorectal laceration following a motorcycle accident. The mechanism of injury remains uncertain, as language barriers prevented clarification of whether a sharp object caused the laceration or if it occurred from blunt force trauma during the fall. ([ Fig. 1 ]) Fig. 1 The black arrow indicates a preserved rectum, while the white arrow indicates an ischiorectal laceration. On admission, the patient's vital signs were stable, and an abdominal examination yielded no significant findings. In the lithotomy position, a 10 cm deep laceration in the ischiorectal fossa was identified, with no involvement of the external sphincters. Computed tomography (CT) showed edema in the pelvic soft tissues and minimal air densities beneath the skin. ([ Fig. 2 ]) Despite these findings, no hematuria was noted, and the patient was treated with debridement, loop colostomy, and suturing. ([ Fig. 3 ]) The patient was discharged on the 8th postoperative day uneventfully. Fig. 2 The red arrow indicates millimetric air density. Fig. 3 View after repair. Literature highlights that early and thorough evaluation of anorectal trauma is essential to prevent complications such as sepsis. As noted by Herzig et al., digital rectal examination and CT scanning are pivotal in the assessment of anorectal injuries, while sigmoidoscopy should be approached with caution due to the risk of exacerbating injuries.[ 1 ] In line with Hassani et al., our case underlines the importance of pelvic debridement and loop colostomy in preventing septic complications.[ 2 ] Furthermore, failure to detect injuries in the upper rectum or sigmoid colon can lead to fatal outcomes, as demonstrated in the case report by Katano et al.[ 3 ] In conclusion, this case emphasizes the necessity of a high index of suspicion and prompt intervention in cases of anorectal trauma, particularly in instances where the mechanism of injury is unclear. Further research is warranted to better understand the management of rare injuries such as ischiorectal lacerations and to optimize patient outcomes. Author's Contribution Oguzhan Fatih Ay: Conceptualized the case, conducted the literature review and comparison, drafted the manuscript, and managed the submission process. Bulent Ozcetin: Supervised the surgical management of the case, provided essential visual materials, and contributed to the manuscript's clinical insights. Yurdukal Deniz Fırat: Guided the academic framing of the letter, provided critical feedback, and encouraged the preparation and submission of the manuscript. All authors reviewed and approved the final version of the manuscript. Publication History Received: 29 September 2024 Accepted: 24 October 2024 Article published online: 18 December 2024 © 2024. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution 4.0 International License, permitting copying and reproduction so long as the original work is given appropriate credit (https://creativecommons.org/licenses/by/4.0/) Thieme Revinter Publicações Ltda. Rua do Matoso 170, Rio de Janeiro, RJ, CEP 20270-135, Brazil

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