Asian Journal of Case Reports in Surgery

Background: We report a rare case of traumatic upper rectal perforation in a 35-year-old female restrained passenger after a front-impact motor vehicle collision with airbag deployment. The patient presented with abdominal and back pain and a lower abdominal seatbelt sign. Vital signs were stable.

Case Report: FAST examination was negative; however, contrast-enhanced CT of the abdomen and pelvis demonstrated pneumoperitoneum and radiologic features suspicious for hollow viscus injury; CT also identified an L2 vertebral fracture. Emergency exploratory laparotomy revealed a 0.7 × 0.7 cm anterior rectal wall perforation just below the rectosigmoid junction and small-bowel contusion 50 cm proximal to the ileocecal valve. The rectal defect was repaired primarily in two layers and a pelvic drain placed. Peritoneal fluid culture grew Escherichia coli; subsequent wound culture grew ESBL-producing E. coli. The patient recovered on ertapenem with resolution of abdominal symptoms, return of bowel function, and improvement of inflammatory markers; superficial surgical site infection was managed with local care.

Conclusion: This case highlights the need for high index of suspicion and prompt operative source control in blunt-trauma patients with seatbelt sign and CT pneumoperitoneum, and supports selective primary repair for small, non-destructive intraperitoneal rectal perforations with appropriate antimicrobial stewardship.