Isolated Rectal Impalement Injuries from Unusual Foreign Bodies: A Case Series from a Tertiary Health Care Facility

Abstract Purpose Rectal impalement injuries from unusual foreign bodies are rare but carry significant morbidity. This study describes the clinical presentation, management, and outcomes of patients with isolated rectal impalement or insufflation injuries managed at a tertiary care centre. Methods Data of 11 patients presenting with rectal impalement or insufflation injuries over a 3-year period (2023–2025) were compiled, including demographics, etiology, mode of injury, clinical features, radiological findings, treatment, and outcome. Results Patients were aged 15–40 years with all males in this study. Self-insertion of the foreign body was the most common mechanism (7 cases), followed by barotrauma from air insufflation during an assault (2 cases), penetrating trauma from a fall from height (1 case), and forceful insertion of a vegetable during an assault (1 case). Erect chest and abdominal X-ray was the only imaging performed in all cases. Seven patients with perforation peritonitis underwent emergency exploratory laparotomy with primary repair and faecal diversion (loop ileostomy or colostomy); one required a Hartmann's procedure and one an end colostomy with distal mucous fistula. Two patients required laparotomy after failed per-rectal retrieval, and two patients had the foreign body retrieved per rectum alone. There was no mortality. Conclusion Rectal impalement injuries require a high index of suspicion, particularly given frequent concealment of history. Early recognition, individualized management ranging from per-rectal retrieval to exploratory laparotomy, and a multidisciplinary approach help optimize outcomes.