Rectal stercoral perforation: an uncommon anatomical localization of a rare surgical emergency

A stercoral rectal perforation is an uncommon cause of acute abdominal pain with only limited cases documented in medical literature. Timely and accurate imaging is essential when this condition is suspected, and immediate surgical intervention is imperative upon confirming the diagnosis of bowel perforation. Usually, the definitive diagnosis of a stercoral rectal perforation is established intraoperatively and a Hartmann procedure with (temporary) end colostomy is performed. In this case report, we present our first-hand experience in managing a stercoral rectal perforation, highlighting the importance of early diagnosis and rapid surgical intervention to achieve favorable outcomes.

Characteristics and Outcomes Associated With Emergent Rectal Foreign Body Management: A Retrospective Cohort Analysis

Background Bedside management and outcomes of rectal foreign bodies remain challenging due to the presentation and complexity of the inserted objects. Injuries, such as perforation of the colon and rectum, are among the most commonly reported complications. However, prior studies are unclear regarding the setting in which the complication rates may be minimized. This study aimed to assess whether there was a statistically significant difference among the various extraction methods with regard to complications in the emergency department and operating room. Materials and methods This was a retrospective study of all cases of rectal foreign bodies that were removed in the emergency department at a large county hospital between 1/1/2010 and 12/31/2020. Patients included in this study were adults who were evaluated and treated in the emergency department. Results A total of 78 patients were included in the final analysis. More than half (51.3%, n=40) of the patients were successfully treated in the emergency department. Compared with the emergency department, patients in the operating room were more likely to undergo exploratory laparotomy and colectomy (0% vs. 31.6%, p<0.0001), undergo general anesthesia (84.2% vs. 0%, p<0.0001), have higher complication rates (21% vs. 0%, p=0.0021), and have a longer hospital length of stay (median=1 vs. 0, p<0.0001). Conclusion This study revealed a >50% success rate of rectal foreign body removal in the emergency department without any reported complications. To improve the success rate of bedside retrieval and decrease complications, physicians need to be vigilant, communicative, and compassionate about their evaluations and clinical methodology.

Rectum Perforation Secondary to Ingested Chicken Bone Presenting as Peri-Anal Abscess: A Case Report

Rectal perforation secondary to an ingested foreign body is a rare occurrence that can be challenging to diagnose. It may initially present as a perianal abscess. Herein, we report a rare incident involving a patient who presented with a perianal abscess. The initial assessment and an abdominal CT scan revealed a large horseshoe perianal abscess with a small linear hyperdensity noted near the anal verge. The patient was taken to the operating room, where he was found to have perforated the rectum due to an ingested chicken bone. The procedure involved the incision and drainage of the abscess, along with the removal of the foreign body.

Rectal Perforation Secondary to a Self-Administered Water-Hose Enema: A Case Report and Literature Review

Chronic functional constipation is a common condition that can have a significant impact on a patient's quality of life and healthcare costs. Hydrostatic enemas are a commonly observed practice among patients with chronic constipation. Rectal perforation is a rare yet serious complication that can be fatal if not diagnosed and treated promptly. Here, we present the case of an elderly lady with Parkinson's disease who presented with upper rectal perforation after using a hydrostatic enema and was treated with Hartmann's procedure. This case highlights the importance of having a low threshold for suspecting and diagnosing colorectal perforation in patients presenting with abdominal pain after receiving a hydrostatic enema.

Extensive subcutaneous emphysema and intra-abdominal sepsis following haemorrhoid operation: a rare complication of a novel procedure

Doppler-guided haemorrhoidal artery ligation and recto anal repair (HAL-RAR) procedure is a relatively new, minimally invasive procedure for the treatment of Grades III and IV haemorrhoids. A 71-year-old female presented with sepsis, abdominal distension and extensive subcutaneous emphysema and was found to have intra- and extraperitoneal rectal perforation requiring repair, laparoscopy and sigmoid colostomy. Suture ligation of the haemorrhoidal artery can inadvertently be above the peritoneal reflection and result in full thickness rectal perforation secondary to ischaemic necrosis. Previous vaginal prolapse mesh repair should be considered as a relative contraindication to HAL-RAR as it can significantly distort the anatomy.

Rare complication of ganglion impar blockade with the transsacrococcygeal approach: A case of rectal perforation

Although it has been reported that caution should be exercised in terms of rectal perforation, as the ganglion impar is located just behind the rectum in the presacral space, the authors could not find any case or images of rectal perforation occurring during ganglion impar blockade in the literature. In this report, the case of a 38-year-old female with rectal perforation that developed during ganglion impar blockade, performed by the transsacrococcygeal approach under fluoroscopy guidance, is presented. Wrong needle selection and the structurally short presacral space of the patient may have influenced the development of rectal perforation in the patient. This study presents the first case and images of rectal perforation in the literature that developed during the application of ganglion impar blockade using the transsacrococcygeal technique. In ganglion impar block applications, technically appropriate needles should be used, and care should be taken in terms of rectal perforation.

Transanal Small Bowel Evisceration in a 3-Year-Old Victim of Motor Vehicle Accident

Although motor vehicle accidents (MVAs) in children are common, pediatric rectal perforations secondary to MVAs leading to transanal evisceration of the small bowel are very rare. Herniation of bowel through breach in the rectal wall seen eviscerating through the anus is a surgical emergency requiring laparotomy and necessary surgical procedure. We report case of a 3-year-old boy, victim of run-over MVA accident, presenting with bilateral fracture shaft femur, fracture of the left humerus, and transanal small bowel evisceration. About 30–40 cm long, gangrenous, small bowel loop was hanging outside the anal canal. Two consecutive surgeries were performed to manage this unusual and complex case with an excellent outcome. This report is presented for an extremely rare presentation of MVA injury in a child.

Emergent Management of Clostridium difficle Infection in a Patient With Chronic Inflammatory Bowel Disease

Clostridium difficle (C. diff) is a well known cause of infectious diarrhea across hospitals in the developed world. An anaerobic, gram positive rod bacteria, C. diff is part of the normal flora of the human colon; however, alterations to the microbiome can promote proliferation leading to pathogenic behavior. Typical symptoms include watery diarrhea in excess of three or more times a day, for at least two days, and abdominal cramping. While most infections do not lead to long term complications, the two complications that are most deleterious to health are toxic megacolon and bowel perforation. Patients with an inflammatory bowel disease are at a higher risk of complications, and thus need to be managed appropriately. This case presents a 39-year-old male, with pertinent medical history of poorly controlled ulcerative colitis, who presented to general surgery with imaging suggesting rectal perforation secondary to a C. diff infection. Due to the free air visualized in the rectum, the patient was urgently transported to the operating room to undergo a total colectomy and end ileostomy surgery. This case discusses the well-known complication of bowel perforation, in order to raise awareness about the management and guidelines. This case is important and significant as it details the appropriate guidelines and structure to follow amongst this unique, and vulnerable to complications, population in order to manage a potentially devastating manifestation of C. diff.

Rectal Perforation following High-Pressure Distal Colostogram

In patients with anorectal malformations and a colostomy, the high-pressure distal colostogram is the technique of choice to determine the type of malformation and thus to plan the surgical repair. Perforations associated with high-pressure distal colostograms are very rare. The aim of our study was to identify pitfalls to prevent perforation secondary to high-pressure distal colostogram. The study included two male patients and was complicated with rectal perforations secondary to high-pressure distal colostogram. Both patients had an imperforate anus without a fistula. One patient had extraperitoneal rectal perforation with progressive contrast spillage into the peritoneum and demised. The other patient developed an extraperitoneal perforation and an associated necrotizing fasciitis of his perineum and scrotum, but he recovered well after debridement. Two further cases of rectal perforation have been described in the literature. Rectal perforation, although rare, is a described life-threatening complication secondary to high-pressure distal colostogram. The cause is excessive contrast pressure. Injection of contrast should be stopped once the distal end of the colon has a convex shape. Intraperitoneal perforation may cause hypovolemic/septic shock, and patients need to be appropriately resuscitated and should undergo laparotomy. Extraperitoneal perforation requires close monitoring for possible local complications, which may necessitate early debridement.

Acute Onset of a Swollen Leg With Crepitus: A Complication With Rectal Perforation

Crepitus happened into the soft tissue is indicated subcutaneous emphysema. Subcutaneous emphysema of leg without trauma was likely to diagnose gas gangrene or gas-forming myonecrosis (GFM) at emergency department (ED). On the other hand, abdominal fatal condition with gas from the gut may spread to the leg should be considered a different diagnosis. We report a case of critically ill patient who presented to the ED with initial features suggestive of necrotizing fasciitis with gas gangrene of left leg. Assessment and further intervention revealed subcutaneous emphysema of leg secondary to a perforation of rectum associated with previous anastomosis site for rectal cancer surgery. Subcutaneous emphysema of the leg rarely happened secondary to perforation of the gastrointestinal tract and has often created serious diagnostic problems which may lead to mortality. Consequently, prompt diagnosis and aggressive treatment is imperative. Physicians and surgeons should be aware of this condition that could be fatal but curable by early intervention.

A rare case of rectal perforation from an accidentally swallowed foreign body

Rectal foreign bodies are not an infrequent presentation and can cause a serious dilemma regarding extraction and management. Management is determined by the site of the injury, degree of fecal contamination, the hemodynamic status of the patient, and comorbidities. Intraperitoneal injuries require surgery in the form of either a primary repair or formal resection with or without diversion. Extraperitoneal perforations maybe managed with presacral drainage and antibiotics with or without diversion.

An adolescent with prolapsed omentum per rectum: Spontaneous rectal perforation managed laparoscopically

Spontaneous rupture of the rectum is a rare occurrence. A total laparoscopic approach to rectal perforation has only occasionally been reported. We report an unusual case of a young boy who developed a spontaneous rupture of the rectum following a trivial fall. A magnetic resonance imaging revealed a tear in the rectum at the peritoneal reflection with the omentum plugging it. He denied any history of rectal instrumentation or abnormal sexual activity. He had no history of constipation or rectal prolapse. The tear was repaired laparoscopically and a covering loop sigmoid colostomy was added. He made an uneventful post-operative recovery. Spontaneous rupture of the rectum can occur in younger age groups and even in the absence of significant trauma. One needs to diligently bring out a history of rectal trauma. Equally important is to rule out any underlying pathological condition. A laparoscopic approach is feasible, especially in early cases.

Pneumothorax, pneumomediastinum, pneumoperitoneum and extensive subcutaneous emphysema resulting from endoscopic mucosal resection secondary to colonoscopy: A case report

Rectal perforation is an unusual complication of therapeutic colonoscopy. The present study reports the case of a patient with a rare manifestation of pneumothorax, pneumomediastinum, pneumoperitoneum and extensive subcutaneous emphysema that resulted from an endoscopic mucosal resection following a colonoscopy of the rectum. Only 3 cases of colonic perforation and 1 case of rectal perforation have been described previously, of which the clinical diagnoses and treatments were varied, and no results of follow-up studies were reported. In the present study, dyspnea and neck swelling were acute signs of extraluminal air that resulted from rectal perforation. Computed axial tomography was an effective diagnosis method, and is recommended for the early recognition of colorectal perforation. Appropriate management and a close follow-up are crucial for optimal results.

Rectal foreign bodies: what is the current standard?

Rectal foreign bodies represent a challenging and unique field of colorectal trauma. The approach includes a careful history and physical examination, a high index of suspicion for any evidence of perforation, a creative approach to nonoperative removal, and appropriate short-term follow-up to detect any delayed perforation.

Retained rectal foreign body with rectal perforation; a complication of the traditional management of haemorrhoids: a case report

Retained rectal foreign bodies are most commonly seen in homosexuals and after assault. A few have been reported after self-treatment of anorectal conditions and prostatic massage. Harmful traditional medical practices have been reported in many communities in Africa but therapeutic anal insertion of foreign bodies for the management of haemorrhoids is rare. We present a patient with features of peritonitis following insertion of a wine bottle into his rectum in an attempt to manage his prolapsed haemorrhoids.

A systematic review of stercoral perforation

AIM

Stercoral perforation is a rarely suspected life-threatening condition. Early diagnosis is difficult but essential. A comprehensive systematic review was performed to evaluate its presentation, diagnosis and treatment.

METHOD

A systematic review was carried out of Embase, MEDLINE, PubMed and Cochrane databases for all articles published between 1998 and 2011. Only studies describing stercoral perforation were included.

RESULTS

Twenty-four relevant articles were found including 137 patients (median age = 62 years) with stercoral perforation, of whom 81% had chronic constipation. Stercoral perforation was diagnosed by CT scan in 90% of 31 patients, with the commonest findings being a combination of faecal impaction (84%) and subphrenic (90%) or extraluminal air (61%). The commonest site of perforation was the sigmoid colon (50%) followed by the rectosigmoid junction (24%). The overall mortality was 34%.

CONCLUSION

Stercoral perforation should be suspected in elderly and chronically constipated patients with unexplained abdominal pain and investigated appropriately with a CT scan to allow timely and optimal treatment.

Severe proctitis, perforation, and fatal rectal bleeding secondary to cytomegalovirus in an immunocompetent patient: report of a case

Cytomegalovirus (CMV) infection is associated with significant morbidity and mortality in immunocompromised patients. In immunocompetent individuals, the infection is usually subclinical but it can sometimes be life threatening. We describe a case of fatal CMV proctitis in a 71-year-old man following an Ivor-Lewis esophagectomy. After surgery he developed renal failure, methicillin-resistant Staphylococcus aureus pneumonia, and acute respiratory distress syndrome. He recovered but developed melena and massive fresh rectal bleeding. Sigmoidoscopy revealed severe proctitis and a biopsy was consistent with ischemia. Despite undergoing a proctectomy he continued to bleed and died despite every effort. The final histological examination of the rectum revealed a CMV infection.