# A Case of Bladder Perforation With Rectal Impalement Injury

## TL;DR

A rare case of combined rectal impalement and bladder perforation is reported, highlighting the importance of considering bladder injury in similar trauma cases.

## Contribution

This case report adds to the limited literature on combined rectal impalement and bladder perforation injuries.

## Key findings

- A 50-year-old man with rectal impalement and bladder perforation was successfully managed with colostomy and transurethral intervention.
- Extraperitoneal bladder perforation can be treated with transurethral coagulation and catheterization without major voiding or defecation dysfunction.
- Gross hematuria in rectal impalement injuries should prompt suspicion of concomitant bladder perforation.

## Abstract

Combined rectal impalement (RI) and bladder perforation (BP) is an extremely rare injury pattern, with limited case reports and no established consensus on their diagnosis and management.

A 50‐year‐old man sustained a perianal impalement injury caused by a metal rod at a construction site. He presented with perianal pain and gross hematuria (GH). Imaging revealed RI and extraperitoneal BP. A colostomy was performed on the same day as the injury, and transurethral coagulation of the bladder (TUC) was performed on the 6th day, during which a bladder mucosal defect was identified. Postoperatively, the GH reduced, and no persistent voiding or defecation dysfunction was observed.

In patients with RI and GH, concomitant BP should be suspected. Although colostomy is almost always required for rectal injury, extraperitoneal BP can be cured with transurethral intervention and catheterization.