A middle-aged lorry-driver was struck a glancing abdominal blow by the fall of a bale of wool he was loading on to his lorry and knocked down. He recovered immediately and drove some 200 miles to the outskirts of London, where he stopped for refreshment. He then had an urge to defaecate, felt somewhat faint, and passed a large quantity of bright red blood rectally. He felt well enough to continue his drive into London, where he reported to hospital some 10 hours after his injury. He had no pain

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... or vomiting and had passed urine normally. On admission, although pale, his general condition was good. His pulse was 108, and his blood pressure was 112/82 mm. Hg. There was no bruising of the abdominal wall. There was slight lower abdominal tenderness and guarding, but no rigidity. Liver dullness was not diminished and peristaltic sounds were present. Proctoscopy showed an empty rectum except for a trickle of blood coming from a vertical linear tear in the upper anterior wall. The upper limit of the tear could not be defined. Laparotomy was performed, and no abnormality was found except in the recto-vesical pouch. There was some slight blood-staining below the pelvic peritoneum, which appeared intact, and also a few small bubbles of gas. It was decided not to attempt suture or