Complex perineal impalement with combined bladder and ileal injury following transpelvic penetration: a case report

Abstract Background Perineal impalement injuries are uncommon yet clinically significant due to their complex diagnostic and therapeutic challenges, especially when involving adjacent visceral components, such as the bladder and small intestine. Early recognition and a multidisciplinary management strategy are essential for optimizing patient outcomes in such high-acuity trauma cases. Case presentation We present the case of a 47-year-old Iranian male who sustained a transpelvic impalement injury following a fall onto a wooden stick. Initial evaluation revealed gross hematuria, abdominal tenderness, and a perineal laceration. Computed Tomography (CT) imaging identified a 30 cm wooden foreign body traversing the pelvis and abdomen, with associated injuries to the bladder, ileum, and perirectal tissues. Surgical intervention included small bowel resection with primary anastomosis, a two-layer bladder repair, diverting sigmoid loop colostomy, and presacral drainage. The postoperative recovery was uncomplicated, with complete functional restoration and no long-term sequelae at 1-year follow-up. Conclusions This case highlights the importance of early multidisciplinary assessment, meticulous preoperative imaging, individualized surgical decision-making, and structured long-term follow-up in managing complex transpelvic impalement injuries. It also illustrates that temporary fecal diversion may be justified in selected patients with severe perirectal soft tissue disruption despite the absence of rectal perforation.