BMJ Case Reports 2009; doi:10.1136/bcr.05.2009.1892
  • Reminder of important clinical lesson

Combined penetrating injury of the perineum and abdominal viscera

  1. Guru P Painuly1,
  2. Dhirendra Singh Negi2
  1. 1
    CMI Hospital Dehradun, Surgery, 54 Haridwar Road, Dehradun, Uttarakhand, 248001, India
  2. 2
    Negi Surgical and Urology Centre, Surgery, Aaraghar, Dehradun, Uttarakhand, 248001, India
  1. Guru P Painuly, gppainuly{at}
  • Published 18 November 2009


This is a rare presentation. A farmer aged 52 years old was brought to the emergency service of Government District (Doon) Hospital in the late evening having significant bleeding per rectum. He had injured his perineum on a sharp wooden stick during a fall near a tube well. The wooden stick had been extracted by his relatives, which had resulted in profuse bleeding. The patient was managed with intravenous crystalloids and rushed to the operating theatre for examination under analgesia. Blood transfusion was arranged and the wound explored under general anaesthesia. The patient had unusual associated visceral injuries as well as sphincter, rectum, urinary bladder, ileal loop and mesentery injuries. The injured bowel, mesentery, urinary bladder and rectum were repaired with diversion of the upper pelvic colon. In addition, debridement of the perineal wound with rectal sphincter repair was performed and the presacral space drained. The colostomy was closed after 3 months, and the patient survived and is continent.


  • Competing interests: None.


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