Abstract
We report a near fatal rectal perforation due to a phosphate enema in an elderly male. The presentation in septic shock within 4 hours of the enema is quite rare. Early recognition and prompt management are essential for a good outcome. A defunctioning colostomy is standard for these cases but we recommend a distal rectal washout since intraluminal faeces in a loaded rectum could be a cause of ongoing sepsis. Although enemas are commonly used for constipation in the elderly, suppositories and oral preparations should be used preferentially where appropriate.
Highlights
Rectal enemas are readily given to the elderly by care givers, most frequently for the treatment of chronic constipation
We report the case of a near fatal rectal perforation in an elderly male secondary to phosphate enema administration, and discuss the management this complication
In the fifteenth and sixteenth centuries a precursor to the modern enema consisting of tubes and metal syringes to introduce weak salt solutions into the rectum was developed [1]
Summary
Rectal enemas are readily given to the elderly by care givers, most frequently for the treatment of chronic constipation. Complications following administration of enemas are uncommon, they can be quite dangerous. We report the case of a near fatal rectal perforation in an elderly male secondary to phosphate enema administration, and discuss the management this complication. The initial surgery following resuscitation of the patient in the majority of the reported cases was a diverting colostomy [6,7].
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