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Case Reports in Medicine
Volume 2011, Article ID 313841, 3 pages
http://dx.doi.org/10.1155/2011/313841
Case Report

Severe Hemoperitoneum after Patient Self-Induced Fecal Evacuation

General Surgery Department, Emergency Surgery Service, University of Ferrara, Corso Giovecca 203, 44100 Ferrara, Italy

Received 6 December 2010; Accepted 4 July 2011

Academic Editor: John Kortbeek

Copyright © 2011 S. Gianesini et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

An increasing incidence of rectal injuries following patient self-induced harmful acts, aimed to sexual or laxatives porpouses, is a fact reported in literature (El-Ashaal et al., 2008). We herein report a case of severe hemoperitoneum related to a middle and upper rectal third seromuscolar tear caused by a self-induced fecal evacuation by means of an arrow with a covered cork tip. An urgent intestinal diversion by means of a Hartmann's operation was performed. The clinical case is presented in relation to the literature debate, regarding the issue of primary repair or resection and anastomosis versus fecal diversion for penetrating rectal injuries (Fabian, 2002; Cleary et al., 2006; Office of the Surgeon General, 1943; Busic et al., 2002). In conclusion, the importance of avoiding an anastomotic breakdown in a patient undergoing a hemorrhagic shock is highlighted.