Conservative Management of Perineal Impalement Trauma with Laparoscopic Approach: Case Report

Author(s): Marcelo Queiroz Oliveira, Fernanda Bombonato Smecellato, Eduardo Bueno Silveira, Giovanni Vitor Garabini, Erick Luís Gobbi, Eloisa Ianes Frota, Natália Yasmin Elisiário Barreto da Silva, José Augusto Pezati Tenani

Perineal impalement injuries are uncommon and involve important structures that can be damaged, leading to a high risk of bleeding and affecting vital structures, which if damaged can result in significant sequelae. The approach to these injuries depends on the patient's hemodynamic stability, the trajectory of the penetrating object, and the resources available at the treatment site. In stable patients, computed tomography allows assessment of vascular injuries, involvement of adjacent structures, and whether the abdominal cavity has been breached. In cases where there is doubt regarding peritoneal violation, diagnostic laparoscopy can be employed. Currently, there are no guidelines for managing these injuries, making them a challenge for surgeons. We present a clinical case of a 17-year-old patient who suffered perineal impalement trauma with a wooden stake following a motorcycle accident, where a laparoscopic approach was chosen due to penetrating trauma associated with free abdominal fluid and uncertainty regarding peritoneal violation after imaging exams. In selected cases, minimally invasive techniques for managing impalement injuries can provide greater safety regarding vital structure involvement while being less invasive and morbid.

Perineal Trauma, Impalement, Laparoscopy, Foreign Body, Perineorrhaphy

1. J Janez, U Stupana, G Norcic. Conservative management of abdominoperineal impalement trauma – A case report. International Journal of Surgery Case Reports 76 (2020) 41–45. https://doi.org/10.1016/j.ijscr.2020.09.060
2. B Xie, CM Leongb, J Joethy, D Kohd. Perineal impalement injury by steel bar — A near miss. Trauma Case Reports 6 (2016) 1–7.http://dx.doi.org/10.1016/j.tcr.2016.09.004
3. BM Shresthaa, DP Koiralab, S Shresthaa, S Kharela, SR Lamichaneb, GR Dahal. Impalement injury of the perineum with an iron rod with minimal injury: A near miss: A case report. International Journal of Surgery Case Reports 80 (2021) 105645.