Authors: Saeed Shoar1, 2, 3 M.D., Zhamak Khorgami1 M.D.
Affiliations: 1 Department of surgery, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
2 Developmental Association for Clinical Study (DACS), Tehran University of Medical Sciences, Tehran, Iran
3 Student Scientific Research Center (SSRC), Tehran University of Medical Sciences, Tehran, Iran
Correspondence to: Saeed Shoar, M.D., Developmental Association for Clinical Study (DACS), Student Scientific Research Center (SSRC), Tehran University of Medical Sciences (SSRC), Tehran, Iran
Email: [email protected]
Conflicting Interest: None declared
Funding Sources: None Declared
Article submitted on: 21st July, 2011
Accepted on: 22ed July, 2011
This clinical image has been peer reviewed
A 34 years old male presented to the emergency department (ED) of Dr Shariati Hospital, Tehran, Iran with the complaints of severe, sharp, non-radiating pain in the anal region from past few hours. At the time of admission in the ED, he was found to have abducted hip joints bilaterally, inability to walk and sit due to the discomfort. However, the patient did not have nausea, vomiting, fever, abdominal pain or associated symptoms at that time.
Patient was vitally stable and general physical examination was unremarkable. Digital rectal exam (DRE) was performed which showed profuse rectal bleeding on observation and a sharp needle like object was felt on palpation. The maneuver was abandoned as patient was screaming because of an excruciating pain.
X-Ray of pelvic region showed a bottle shaped hollow glass tube with broken edges in the lower pelvic region (Figure 1). Further discussion with the patient after the results of radiological imaging revealed that the patient had a street fight with a gang of drug dealers.
Consulatations were placed for the general surgery, dermatology, psychiatry and infectious disease medicine department. Social Security Guards were also informed of the case. Furthermore, evidences were also collected for the possible homicide.
Following the consultations with other specialties, the patient was sedated and the site of trauma was washed with 1 liter of normal saline and then anesthetized and lubricated. Lock forceps was used to pull the bottle gently from the anal canal. After this procedure, the local area was washed and then packed with sterile lubricated packing.
The patient was discharged on ibuprofen 400 mg/QID orally for pain, cephalexin 500 mg/ QID orally for skin lesions of perineum and ceftriaxone 1 g/ BD IV for the possible internal trauma to rectal and anal canal mucosa. No further interventions and recommendation were made.