Penetrating injury of rectum and vertebral body by steel bar causing cauda equina syndrome.

STUDY DESIGN: Case report.

OBJECTIVE: To report an extremely rare case of combined penetrating injury to rectum and vertebral body by steel bar causing cauda equina syndrome.

SUMMARY OF BACKGROUND DATA: Only one similar case has been reported. Our case was more severe and posed more challenges to physicians.

METHODS: A 37-year-old male had a penetrating rectal injury by a long steel bar as a result of a falling accident. He was firstly treated with removal of the bar, debridement, and fecal diversion. Spine and cauda equina injuries were found the second day by lumbar and sacral CT. Because of infection after the first surgery, decompressive surgery was performed 2 months from injury. Cerebrospinal fluid fistula happened on the 12th day after surgery which was managed by debridement, irrigation and drainage, suture of the leaking skin and combined use of antibiotics.

RESULTS: When being discharged, he could ambulate independently but could not control his voiding. The colostomy and urinary canal was preserved during the follow-up.

CONCLUSION: Steel bar penetrating injury of rectum and vertebral body can be severe and cause complex injuries. Complications included infection and cerebrospinal fluid fistula. Thorough history and physical examination and CT and MRI inspection are very important for timely diagnosis and early treatment of spine and cauda equina injuries. Dural tear should be carefully inspected and repaired during posterior lumbar decompression surgery. Cooperation of experienced surgeons from orthopedics and gastrointestinal department is needed to give the patient the most appropriate treatment and improve prognosis.