Extraperitoneal Rectal Perforation Research Articles

Buttock Mass: A Typical Feature of Fetal Extraperitoneal Rectal Perforation

Buttock Mass: A Typical Feature of Fetal Extraperitoneal Rectal Perforation

Extra-peritoneal rectal perforation from self-administered enema.

Extra-peritoneal rectal perforation from self-administered enema.

Penetrating Rectal Wound in Domestic Injury

An 11-year-old boy tried to jump over a metal rod but landed on it presented with perianal pain and rectal bleeding. On examination, there is a 1.5cm perineal laceration. His blood results showed a normal TWC with a normal abdominal and chest radiographs. His vital signs were within normal limits. He was planned for bedside T&S by ED team but deferred as persistent blood oozing from rectal, thus referred to Paediatric Surgery. Upon review, there was 2x1cm perianal laceration at 7 o’clock, abrasion wound at 10 & 12 o’clock. Ultrasound showed no free fluid. He was taken to emergency OT for EUA, intraoperative findings were a perianal laceration, on table sigmoidoscopy showed posterior rectal wall irregularities with slow oozing blood from it, however, no obvious perforation seen. The patient developed fever with lower abdominal tenderness on the following day. Urgent CECT abdomen pelvis performed and showed features of extraperitoneal rectal perforation. He was treated conservatively with antibiotics and NBM with parenteral nutrition support. He made a good recovery and was discharged home on day 9. Pediatric perineal impalement injuries often caused by falls on an offending object. These children are prone to severe injuries as compared to adults and the lesions in the pediatric perineum may appear innocuous, but can be potentially life-threatening and surgically challenging. Perineal impalement injuries in children are classified as transanal or perineal and further subdivided as extraperitoneal or intraperitoneal. This classification method is used to predict potential injuries and develop treatment guidelines. Evaluation of perineal impalement injuries in children needs to be thorough even in the presence of minimal or no symptoms.

Fetal extraperitoneal rectal perforation

Fetal extraperitoneal rectal perforation is a very rare condition, but prompt diagnosis and appropriate treatment produce overall good outcome. Its etiology and pathophysiology are poorly understood. Only 16 cases have been reported worldwide. We report another case of fetal extraperitoneal rectal perforation managed by us. Keywords : extraperitoneal, fetal, rectal perforation Department of Pediatric Surgery, Choithram Hospital & Research Centre, Indore, Madhya Pradesh, India

Hollow viscus injury due to blunt abdominal trauma

Background: Management of hollow viscus injury (HVI) due to blunt abdominal trauma (BAT) is a challenge to the clinicians even in the era of advanced imaging and enhanced critical care. Repeated clinical examination with appropriate imaging with multidisciplinary teamwork is the key for timely intervention in equivocal cases for successful outcomes. Aim of the study was to present our experience over last 4½ years.Methods: This is a retrospective study of prospectively collected data of patients treated at surgical gastroenterology department, Nizam’s Institute of Medical Sciences, Hyderabad, India over a period of 4½ years (2012-2016).Results: A total of 126 BAT Patients were treated in our unit as inpatients during the last 4½ years. Out of 126, twenty patients (15.87%) with HVI in whom surgical intervention was done formed the study group. Contrast enhanced CT Scan abdomen and chest was done in stable patients (13/20), in rest of the patients (7/20) the decision to operate was taken more on clinical grounds along with X-ray abdomen and USG abdomen features. 12 (60%) had jejunal and ileal injuries, 5 (25%) patients had colonic injuries (sigmoid 4, caecum 1). One (5%) patient had extra peritoneal rectal perforation with ascending retroperitoneal fascitis and 2 (10%) had duodenal injury. Two (10%)patients required relaparotomy. We had mortality in 3 (15%) patients and 17 (85%) patients had complete recovery.Conclusions: Hollow viscus injury should be suspected in all cases of blunt abdominal trauma. In equivocal cases careful repeat clinical examinations with close monitoring and repeat imaging is highly essential to prevent delay in intervention. Type of procedure is based on time of presentation, degree of contamination, associated injuries and general condition of the patient.

An unusual stab wound to the buttock

Stab wounds to the buttock are uncommon injuries that are rarely seen in surgical civilian practice. Although, the wound appears trivial, it may cause major life-threatening visceral and vascular injuries. Failure to detect these injuries may lead to serious morbidity and mortality. Herein, we report a patient with a single gluteal stab wound, which was initially sutured and treated conservatively. Two days later, patient developed fever, lower abdominal pain and tenderness with leakage of fecal material from the wound. Exploratory laparotomy revealed an extraperitoneal rectal perforation for which a Hartmann's procedure was performed. Computed tomography scanning is recommended as a diagnostic tool for stable patients having buttock stab wounds. Diverging colostomy is the standard surgical procedure for extraperitonal rectal injuries that cannot be properly visualized and repaired during a laparotomy. More evidence is needed to assess the fecal non-diversion approach in the treatment of these patients.

Fetal Extraperitoneal Rectal Perforation in a Preterm Baby

Fetal Extraperitoneal Rectal Perforation in a Preterm Baby

Fetal extraperitoneal rectal perforation presenting after duodenal atresia repair

Fetal extraperitoneal rectal perforation (FERP) is a very rare condition, but prompt diagnosis and appropriate treatment produce overall good outcome. We report the first case of FERP known to be associated with duodenal atresia, which only became clinically apparent after duodenal atresia repair and initially presented a diagnostic difficulty. Our case was successfully treated with a defunctioning colostomy and subsequent excision of the pseudocyst cavity. Proximal atresias can mask the presentation of FERP, and this diagnosis should be considered in cases of neonatal perineal and buttock swelling.

Extra-peritoneal rectal perforation caused by water jet: a case report and literature review

The use of motorised watercrafts has been increasing steadily over the past few years, and consequently, also injuries secondary to the use of these watercrafts [1]. This is a case presentation and review of literature. We present a case of isolated extraperitoneal rectal perforation secondary to hydrostatic pressure sustained. Both PubMed and Web of Science were searched using the following keywords: rectal perforations; intra-peritoneal; extra-peritoneal; motorised watercraft; and Jet Ski. We found two similar rectal injuries caused by motorised watercrafts, but both were intraperitoneal rectal perforations. To our knowledge, this is the first reported case of extra-peritoneal rectal perforation after falling off a motorised watercraft. On the other hand, vaginal perforation after such a trauma is well documented in many series. Though there injuries are not very common, they can be life-threatening. Simple measures like wearing protective garments might be enough to prevent them. Complete defunctioning colostomy is better in these cases than partially defunctioning colostomy.

Fetal extraperitoneal rectal perforation: a rare neonatal emergency

Purpose Intraperitoneal bowel perforation may occur in utero as a result of a variety of abnormalities and typically results in sterile meconium ascites, pseudocysts, and/or calcification in the fetus. On the other hand, extraperitoneal bowel perforation in intrauterine life is extremely rare. The object of this report is to present our experience of prenatal extraperitoneal rectal perforation, defining the clinical presentation, management, and progress. Methods and Materials Nine babies who were identified from 2 centers in the Republic of South Africa with fetal extraperitoneal rectal perforation are presented. The details of these babies were obtained retrospectively from the case notes. Results All patients presented at or shortly after birth with air and meconium tracking below the pelvic floor manifesting as either an expanding, meconium-stained aerocele or with perirectal spreading sepsis. Where abdominal signs were present, laparotomy confirmed the extension of the meconium perforation into the peritoneal cavity. Management was by diverting colostomy, drainage of the perineal collection, and supportive therapy. A posterior approach to the rectum and excision of a fibrotic section of the lower rectal wall was performed in one case. One case developed rectal stenosis that was treated by dilatation before colostomy closure. In all the other cases, digital examination performed before colostomy closure ruled out significant narrowing. There was no mortality, and the site of the rectal perforation healed in all cases to leave good anorectal function after treatment. Conclusions Fetal extraperitoneal perforation is extremely rare, but the clinical features are easily recognizable, and when appropriate therapy is instituted, the outcome is likely to be good with normal anorectal function to be expected in the long-term. The exact cause of the condition is unknown.

Obturator Internus Tear After Colonoscopy

A 59-year-old male presented to his physician two days after a colonoscopy with complaints of severe bilateral groin pain limiting his daily activities. The colonoscopy was reported as being uneventful except for difficulty with positioning. The patient was admitted and subsequently transferred to our facility for further care after a febrile episode. The patient had severe pain with flexion of his left hip joint and a burning pain on the medial aspect of his left thigh. His past medical history was significant for hypertension and an asymptomatic pericardial effusion diagnosed several years earlier. On examination, we found an obese male with no evidence of any sensory or motoe neurological deficit in his genitalia or thigh region. A rectal examination revealed no abnormality and minimal tenderness. The patients' initial evaluation with a computerized tomographic scan revealed no abnormality and a magnetic resonance imaging (MRI) study (Figure) was obtained to further evaluate the pelvis, which revealed a tear in the obturator internus muscle with edema. Blood cultures obtained on the patient after his initial febrile episode revealed gram-negative rods in two cultures. The patient had resolution of his symptoms with increasing activity, had normal bowel movements and remained afebrile on antibiotics and was discharged home. The obturator internus muscle originates from the internal surface of the obturator membrane and the bony margins of the obturator foramen and attaches to the medial surface of the greater trochanter of the femur, thus, helping in abduction and lateral rotation of the thigh. It is supplied by the obturator nerve, which also provides cutaneous innervation to the medial thigh via the anterior branch. We believe that the patient sustained a microscopic rectal perforation during the procedure, which resulted in his septicemia. The injury to the obturator muscle may have been coincidental from patient positioning. Isolated injuries to the obturator internus muscle are rare. An MRI usually determines diagnosis and treatment for this includes physical therapy and pain control. Extra-peritoneal rectal perforation created during colonoscopy can often be watched (1) and subsequent drainage procedures may be necessary.

Endoscopic trans-anal resection for palliation of acutely obstructed rectal cancer in frail elderly patients

Obstructive carcinomas of the rectum in frail elderly patients who are not candidates for curative surgery have been traditionally treated by diverting loop colostomy. This is a retrospective evaluation of the outcome of endoscopic trans-anal resection (ETAR) for obstructed rectal cancer. Fifty-two patients with a mean age of 82 (range 76–90) years and severe concomitant disease underwent ETAR which was carried out without general anaesthesia with a 27-French two-way Iglesias resectoscope. Mean distance from the anal verge was 6 (range 4–12) cm. Obstruction was relieved in all patients with one resection, 30-day- mortality rate was 2% (myocardial infarction in a 90-year-old-patient), the 10% morbidity rate (5/52 patients) was not directly ETAR-related, and extraperitoneal rectal perforation in one patient (2%) was uneventful. In conclusion, ETAR offers good palliation in selected patients.

Extraperitoneal Rectal Perforation due to Retroflexion Fiberoptic Proctoscopy

The increasing use of retroflexion proctoscopy to evaluate the distal rectum is not without complications. We report a series of three patients who experienced extraperitoneal rectal perforation secondary to retroflexion proctoscopy and discuss our success with conservative management. By evaluating each clinical situation individually and following certain principles, successful outcome can be achieved without surgical intervention. Success depends on several factors: 1) the injury must be below the peritoneal reflection; 2) the patient must have undergone a complete bowel preparation before endoscopy; 3) postinjury, the patient must continue to show no evidence of peritonitis or hemodynamic instability; and 4) the patient must be given nothing by mouth, started on intravenous antibiotics and possibly parenteral nutrition, and closely monitored with serial abdominal examinations. The presence of comorbid conditions does not necessarily diminish the chance that conservative therapy will succeed.

Rectal “oven mitt”: the importance of considering a serious underlying injury

A 20-year-old man presented with a rectal “oven mitt,” which was removed transanally. Rigid proctosigmoidoscopy revealed no apparent perforation, but subsequent contrast enema using meglumine diatrizoate demonstrated an extraperitoneal rectal perforation, which was probably caused by a wooden stick used to forcefully introduce the glove through the patient’s anus. Thus, rectal injuries may be caused not by the foreign object itself, but by another object used as an introducer.

Retention balloon catheters and barium enemas: Attitudes, current practice and relative safety in the UK

Balloon catheters have been associated with increased morbidity and mortality leading some to believe they should be banned, yet others find them both useful and safe if used properly. Questionnaires were sent to all Consultant Radiologists in the UK to document current practice. Particular attention focused on whether eight safety aspects are considered during their use. In this entirely retrospective study complications with both balloon and standard tip catheters were recorded during the 3-year-period 1992 to 1994 to assess their relative safety. Twenty-two percent of UK Radiologists routinely used a rectal balloon. This was not associated with any increase in mortality, but extraperitoneal rectal perforation was increased by a factor of 2.5. The routine use of retention balloon catheters may not be justified.