Retrorectal Abscess After Abdominal Blunt Trauma

Aim To discuss an extended retrorectal abscess secondary to blunt abdominal trauma as a cause of abdominal wall (AW) infection and impairment. Methods We describe a case of blunt abdominal trauma with late diagnosis of jejunal perforation with an abscess that extensively dissected the retrorectus space. Results A 65 years-old female patient suffered multiple trauma after traffic collision. Ten days after admission, she presented fever and right abdominal swelling and induration. CT scan showed pneumoperitoneum and an extensive collection affecting the right retrorectal space until the ribs with preperitoneum. Urgent laparotomy was performed and found a jejunal perforation with fecal peritonitis and extraperitoneal extension with dissection of the whole right retromuscular space. Intestinal resection with anastomosis was performed. Exhaustive lavage of the cavity and retromuscular space with debridement of the necrotic posterior rectal lamina was required and a retrorectal drainage was placed. Primary closure of the aponeurosis was achieved with small bites technique and absorbable monofilament. Due to the weakness of the abdominal wall, an absorbable biosynthetic mesh impregnated with gentamicine was placed onlay. Negative pressure therapy was applied on the wound. Patient received antibiotics and CTs showed favourable evolution. No infectious complications or incisional hernia have been reported after more than 10 months of follow-up. Conclusion Literature does not report cases of blunt trauma causing extensive AW infection. Whilst rare, it should be considered in traumatic patients. Our experience shows they can be managed with surgical drainage and in case of fascial loss and AW weakness, absorbable meshes could be considered.