Metallica chair does not spare the sphincter: successful operative reconstruction of an extraperitoneal rectal injury with sphincter involvement

Extraperitoneal rectal injuries are uncommon and traditionally managed with fecal diversion, particularly when sphincter involvement is present. We report a case of a 26-year-old male who presented 5 days after a low-energy rectal impalement caused by a collapsed metal chair, with persistent rectal pain, fecal incontinence, and purulent drainage following initial repair at an outside institution. Examination under anesthesia revealed a posterior rectal laceration extending 6 cm from the anal verge, involving ~25% of the rectal circumference with disruption of the internal anal sphincter. After thorough debridement, an overlapping sphincteroplasty was performed without fecal diversion due to viable tissue, minimal contamination, preserved external sphincter function, and hemodynamic stability. The patient recovered uneventfully. This case highlights the feasibility of selective non-diverted management of extraperitoneal rectal trauma with sphincter involvement in carefully selected patients.