A brush with danger: operative management of a through and through urethral and rectal injury following paintbrush insertion into the urethra.
R Karanjia, D Whiting, M Qureshi et al.
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Case in brief
A 61-year-old man presented to the emergency department after inserting a 15 cm paintbrush into his urethra. The injury had created two urethral exit defects and an associated rectal injury. Surgeons repaired the urethral defects primarily over a urethral catheter, with a suprapubic catheter for diversion, and repaired the rectum with a covering laparoscopic defunctioning colostomy. He recovered fully and had no residual urinary symptoms.
What made this case unusual
The injury combined two urethral exit defects with rectal injury after urethral foreign-body insertion; the authors reported no prior cases of this combination.
Diagnostic / clinical pearl
Urethral foreign-body insertion can cause injury beyond the urethra, including rectal damage. Assessment and operative planning should account for associated injury when the mechanism suggests transfixion.