Traumatic Extraperitoneal Rectal Injury with Anal Sphincter Disruption: A Case Report

Traumatic rectal injuries are rare but potentially life-threatening, particularly in blunt trauma, where diagnosis may be delayed and morbidity remains high. Management strategies have evolved from dogmatic approaches toward selective, anatomy-based treatment. We report the case of a 21-year-old man who presented following a fall onto sharp metallic bars from a height of 1.5 meters, resulting in direct posterior perineal trauma. Clinical examination revealed generalized abdominal guarding and a low posterior anal laceration associated with sphincter atony. Plain abdominal radiography demonstrated pneumoperitoneum. Surgical exploration identified multiple extraperitoneal rectal injuries, complete anal sphincter disruption, and sigmoid parietal pneumatosis without transmural colonic perforation. Management consisted of transanal repair of rectal wounds, sphincter reconstruction, and protective sigmoid colostomy. Postoperative recovery was uneventful, with restoration of bowel continuity two months later and satisfactory sphincter function. This case highlights the diagnostic challenges and therapeutic considerations of blunt rectal trauma. Early recognition, systematic evaluation combining imaging and endoscopic assessment, and tailored surgical management are essential to optimize outcomes. Selective primary repair with judicious fecal diversion remains a safe and effective strategy in appropriately selected patients