A 27-year-old homosexual male presents with a foreign body in the rectum. During the extraction of the foreign body, a large tear in the sigmoid colon with extensive devitalization and contamination is observed. What is the preferred method of treatment?
Rectosigmoid injuries should promptly raise a high index of suspicion, warranting immediate sigmoidoscopy to confirm the diagnosis. Sigmoidoscopy, rigid or flexible, involves much manipulation and insufflation of air. This is hardly desirable or safe in the presence of a significant tear in the presence of a rectal foreign body, free air under the diaphragm, in a patient with an acute abdomen, is all that is necessary to warrant laparotomy. Following this, CT scan with gastrofin administered orally, will give the diagnosis. The best treatment is exteriorization that is colostomy, at the perforated site. This will depend upon the location and extent of the perforation. If small and localized, colostomy at the site or proximally may be chosen. If the tear is massive, then resection with proximal colostomy and mucous fistula (Hartman) may be indicated.
Observation
Proctoscopic repair
Laparotomy and closure of sigmoid colon tear
Laparotomy, closure of sigmoid, and proximal colostomy or exteriorization of perforation as a colostomy
Small & Large Intestine