Transanal Intrusion Avoided: A Rare Case of Pediatric Accidental Penetrating Gluteal Trauma Induced by a Pencil Without Internal Perforation

Penetrating injuries to the gluteal region are rare in children and often pose a diagnostic and therapeutic challenge due to the proximity of vital pelvic structures such as the rectum, bladder, and major vessels. Injuries caused by common classroom supplies like pencils are uncommon, but their ability to penetrate deeply into the pelvis warrants high suspicion for visceral injury. Here, we report a case of an 11-year-old previously healthy boy who suffered a left-sided gluteal injury after unintentionally sitting on a pencil placed upright on a chair as a prank during school hours. Initial assessment showed a puncture wound without external bleeding or signs of peritonitis. Contrast-enhanced computed tomography (CT) of the pelvis revealed a linear foreign body measuring 12.4 cm in length passing through the ischiorectal fossa and appearing to penetrate the posterior rectosigmoid wall, with the tip located inside the lumen. Despite imaging suggesting rectal perforation, diagnostic laparoscopy and colonoscopy showed no mucosal injury, contamination, or any signs of perforation. The foreign body was successfully removed through the entry wound, and the patient was managed conservatively with intravenous antibiotics and close clinical monitoring. Postoperatively, he developed abdominal pain and elevated inflammatory markers, with ultrasound revealing a small retrorectal fluid collection that improved with ongoing conservative care. He fully recovered and remained asymptomatic on follow-up. The aim of the report is to highlight a rare case and underscore the importance of correlating imaging findings with surgical and endoscopic assessments in pediatric trauma and support a purposeful, minimally invasive targeted treatment approach in the absence of obvious perforation or systemic compromise.