Occult extraperitoneal rectal injury and necrotizing fasciitis of the thigh following traumatic pelvic fracture: case report
Abstract
Extraperitoneal rectal injuries following blunt trauma are rare and often difficult to diagnose. In the setting of pelvic fractures, these injuries may be missed on initial imaging, leading to severe complications. We report a 40-year-old male who sustained a pelvic crush injury. Computed tomography (CT) demonstrated complex pelvic fractures with no evidence of rectal injury. Subtle extraperitoneal perirectal air was identified on further imaging. On day 13, he developed sepsis without an obvious source. Repeat CT revealed an extraperitoneal rectal perforation with extensive air tracking into the pelvic soft tissues and thigh. The patient underwent emergent surgical intervention including loop colostomy, proctoscopy, and extensive debridement for necrotizing soft tissue infection (NF). He subsequently improved with staged debridement and negative pressure wound therapy. This case highlights the diagnostic challenges of occult extraperitoneal rectal injuries. Unexplained extraperitoneal air should prompt further evaluation with endoscopy. Delayed diagnosis resulted in life-threatening complications e.g. NF.
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BibTeX
@article{alahmad2026occult,
title = {{Occult extraperitoneal rectal injury and necrotizing fasciitis of the thigh following traumatic pelvic fracture: case report}},
author = {Murad Alahmad and Fernando Spencer Netto and Ibrahim Afifi and Ahmed F Ramzee and Ruben Peralta and Mohamed H Ahmed and Ayman El-Menyar and Hassan Al-Thani and Sandro Rizoli},
journal = {Journal of surgical case reports},
year = {2026},
month = oct,
doi = {10.1093/jscr/rjag1015},
url = {https://europepmc.org/article/PMC/PMC13725753},
note = {CC BY},
}
RIS
TY - JOUR
TI - Occult extraperitoneal rectal injury and necrotizing fasciitis of the thigh following traumatic pelvic fracture: case report
AU - Murad Alahmad
AU - Fernando Spencer Netto
AU - Ibrahim Afifi
AU - Ahmed F Ramzee
AU - Ruben Peralta
AU - Mohamed H Ahmed
AU - Ayman El-Menyar
AU - Hassan Al-Thani
AU - Sandro Rizoli
PY - 2026
DA - 2026/10/01
JO - Journal of surgical case reports
DO - 10.1093/jscr/rjag1015
UR - https://europepmc.org/article/PMC/PMC13725753
AB - Extraperitoneal rectal injuries following blunt trauma are rare and often difficult to diagnose. In the setting of pelvic fractures, these injuries may be missed on initial imaging, leading to severe complications. We report a 40-year-old male who sustained a pelvic crush injury. Computed tomography (CT) demonstrated complex pelvic fractures with no evidence of rectal injury. Subtle extraperitoneal perirectal air was identified on further imaging. On day 13, he developed sepsis without an obvious source. Repeat CT revealed an extraperitoneal rectal perforation with extensive air tracking into the pelvic soft tissues and thigh. The patient underwent emergent surgical intervention including loop colostomy, proctoscopy, and extensive debridement for necrotizing soft tissue infection (NF). He subsequently improved with staged debridement and negative pressure wound therapy. This case highlights the diagnostic challenges of occult extraperitoneal rectal injuries. Unexplained extraperitoneal air should prompt further evaluation with endoscopy. Delayed diagnosis resulted in life-threatening complications e.g. NF.
SN - 2042-8812
ER -