Although traumatic injuries to the rectum are not uncommon, they pose significant challenges to surgeons. Challenges relate to timely diagnosis, control of pelvic hemorrhage, multiplicity of associated injuries, difficulties in operative exposure, and prevention of sepsis. We report an unusual case of combined rectal and vertebral body penetrating injuries by a long rusty steel bar as a result of a falling accident. Successful treatment of this condition entailed removal of the bar, perineal and retroperitoneal drainage, and fecal diversion. The patient was discharged without neurologic, hemorrhagic, or intestinal morbidities 20 days later. Closure of colostomy was performed three months later uneventfully.
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