Rectal foreign body insertion as a rare cause of persistent lumbosacral plexus injury

• Published in: Annals of the Royal College of Surgeons of England 2017-07, Vol.99 (6), p.e191-e192
• Main Authors: Meister, F A, Amygdalos, I, Neumann, U P, Lurje, G
• Format: Article
• Language: English
• Subjects: Aged; Colon; Fecal Incontinence; Foreign Bodies - complications; Foreign Bodies - diagnostic imaging; Foreign Bodies - surgery; Humans; Ileostomy; Lumbosacral Plexus - injuries; Male; Medical imaging; Online Case Report; Ostomy; Paralysis; Patients; Peripheral Nerve Injuries - etiology; Proctoscopy; Rectum - diagnostic imaging; Rectum - injuries; Rectum - surgery; Spinal cord injuries; Surgery; Urinary Incontinence
• ISSN: 0035-8843; 1478-7083
• DOI: 10.1308/rcsann.2017.0109

Rectal foreign body insertion is a common condition in emergency surgery, which often requires surgical intervention. Here we report a clinical case of rectal foreign body insertion as a rare cause of persistent lumbosacral plexus injury. A 72-year-old man presented to the emergency department complaining of acute bilateral paraplegia with loss of sensation in both legs, as well as total urinary retention. The patient underwent abdominal computed tomography, which showed a rectal foreign body measuring 13 × 11.5 × 10 cm in the lower abdomen and pelvis. Extraluminal assistance through a median laparotomy was required after unsuccessful attempts at transanal recovery alone. After removal of the foreign body, the rectal wall and anorectal sphincter were massively dilated, with severe bruising of the rectal mucosa on proctoscopy. A protective loop-ileostomy was performed. The sacral plexus is located posteriorly in the pelvis. Physiologically, the nerves are well protected by surrounding anatomical structures. Post-traumatic lumbosacral plexus injuries with paraplegia, urinary retention and anorectal sphincter insufficiency occur quite frequently after heavy traffic accidents. Lumbosacral plexus injury as a result of rectal foreign body insertion is rare. Severe neurological deficits through rectal foreign body insertion are rare but known medical conditions. To the best of our knowledge, this is the first reported case of severe and persistent post-traumatic lumbosacral plexus injury through a rectal foreign body.