Annals of Coloproctology

Case Reports

Malignant disease,Rare disease & stoma,Complication

Colonic Perforation After Treatment With Nivolumab in Esophageal Cancer: A Case Report: Hye Jung Cho, Woo Ram Kim, Joo-Hang Kim, Duk Hwan Kim, Dae Jung Kim, Haeyoun Kang; Ann Coloproctol. 2021;37(Suppl 1):S39-S43. Published online June 24, 2021; DOI: https://doi.org/10.3393/ac.2020.00213.0030

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With the advent of checkpoint inhibitors, it has opened up opportunities for numerous cancer patients. However, as is the case with every treatment, complications need to be weighed. Gastrointestinal adverse effects, such as diarrhea and colitis are well-known complications for checkpoint inhibitors. In severe cases, colitis-induced colonic perforation may occur with an estimation of 1.0% to 1.5% in anti-CTLA-4 antibodies. However, only a handful of cases of such devastating complications have been reported in anti-PD-1 antibodies such as pembrolizumab and nivolumab. We here report a case of intestinal perforation in a patient treated with nivolumab.

Citations

Citations to this article as recorded by

Chemotherapy-associated pneumoperitoneum in cancer patients: a scoping review
Renee M. Maina, Caroline Rader, Jeevan Kypa, Constantine Asahngwa, Hilary M. Jasmin, Nia N. Zalamea, John S. Nelson, Jonathan L. Altomar, Mary Brinson Owens, Clarisse S. Muenyi, Denis A. Foretia
Annals of Medicine & Surgery.2024; 86(5): 2828. CrossRef
Gastrointestinal perforation associated with novel antineoplastic agents: A real-world study based on the FDA Adverse Event Reporting System
Zicheng Yu, Haibin Zhu, Hongjun Chen, Lifei Zhu, Xiaolan Liao
Journal of Pharmacy & Pharmaceutical Sciences.2023;[Epub] CrossRef
Gastrointestinal and Hepatobiliary Immune-related Adverse Events: A Histopathologic Review
Zainab I. Alruwaii, Elizabeth A. Montgomery
Advances in Anatomic Pathology.2023; 30(3): 230. CrossRef
An updated review of gastrointestinal toxicity induced by PD-1 inhibitors: from mechanisms to management
Yiyu Cheng, Fangmei Ling, Junrong Li, Yidong Chen, Mingyang Xu, Shuang Li, Liangru Zhu
Frontiers in Immunology.2023;[Epub] CrossRef
Nivolumab

Reactions Weekly.2022; 1892(1): 181. CrossRef
Gastrointestinal and Hepatobiliary Immune-related Adverse Events: A Histopathologic Review
Zainab I. Alruwaii, Elizabeth A. Montgomery
Advances in Anatomic Pathology.2022; 29(4): 183. CrossRef

Benign GI diease

Small Bowel Perforation Associated With Gastrointestinal Graft-Versus-Host Disease and Cytomegalovirus Enteritis in a Patient With Leukemia: A Case Report With Literature Review: Kwang-Seop Song, Min Jung Kim, Han-Ki Lim, Yoon Hwa Hong, Sung Sil Park, Chang Won Hong, Sung Chan Park, Dae Kyung Sohn, Kyung Su Han, Jae Hwan Oh; Ann Coloproctol. 2020;36(4):281-284. Published online August 31, 2020; DOI: https://doi.org/10.3393/ac.2018.10.01.1

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Gastrointestinal graft-versus-host disease (GVHD) is a common complication after hematopoietic stem cell transplantation. Concomitant cytomegalovirus (CMV) enteritis worsens the prognosis of this condition. We report a case of small bowel perforation associated with gastrointestinal GVHD and CMV enteritis in a patient with leukemia who was successfully treated surgically. A 39-year-old man presented with intestinal perforation necessitating emergency surgical intervention. He was diagnosed with T-cell acute lymphoblastic leukemia and developed severe gastrointestinal GVHD and CMV enteritis after hematopoietic stem cell transplantation. His terminal ileum showed a perforation with diffuse wall thinning, and petechiae were observed over long segments of the distal ileum and the proximal colon. Small bowel segmental resection and a subtotal colectomy with a double-barreled ileocolostomy were performed. The patient recovered uneventfully after the operation. Based on reports described in the literature, surgery plays a minor role in the management of gastrointestinal GVHD; however, timely surgical intervention could be effective in selected patients.

Citations

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Cytomegalovirus enteritis resistant to antiviral drugs improved following total colectomy
Sae Kawata, Jumpei Takamatsu, Yuichi Yasue, Aya Fukuhara, Jinkoo Kang
Surgical Case Reports.2023;[Epub] CrossRef

Benign GI diease,Rare disease & stoma,Complication

Intestinal Perforation as a Paradoxical Reaction to Antitubercular Therapy: A Case Report: Sung Hoon Kang, Hee Seok Moon, Jae Ho Park, Ju Seok Kim, Sun Hyung Kang, Eaum Seok Lee, Seok Hyun Kim, Byung Seok Lee, Jae Kyu Sung, Hyun Yong Jeong, Kyung Ha Lee; Ann Coloproctol. 2021;37(Suppl 1):S18-S23. Published online May 15, 2020; DOI: https://doi.org/10.3393/ac.2020.03.16.1

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Paradoxical reactions to tuberculosis (TB) treatment are characterized by an initial improvement of the clinical symptoms followed by clinical or radiological deterioration of existing tuberculous lesions, or by development of new lesions. Intestinal perforation in gastrointestinal TB can occur as a paradoxical reaction to antitubercular therapy. A 55-year-old man visited the outpatient department with lower abdominal pain and weight loss. He was diagnosed with intestinal TB and started antitubercular therapy. After 3 months of antitubercular therapy, a colonoscopy revealed improvement of the disease. Three days after the colonoscopy, the patient visited the emergency room complaining of abdominal pain. Abdominal computed tomography revealed extraluminal air-filled spaces in the pelvic cavity. We diagnosed a small bowel perforation and performed an emergency laparotomy and a right hemicolectomy with small bowel resection. This report describes the case of intestinal perforation presenting as a paradoxical reaction to antitubercular and provides a brief literature review.

Citations

Citations to this article as recorded by

Réaction paradoxale tuberculeuse
L.-D. Azoulay, A.-L. Houist, E. Feredj, W. Vindrios, S. Gallien
La Revue de Médecine Interne.2024; 45(5): 279. CrossRef
Paradoxical Reaction to Antitubercular Treatment Causing Colonic Obstruction
Akira Hokama, Yuiko Oishi, Erika Koga, Sayuri Takehara, Jiro Fujita
Chonnam Medical Journal.2022; 58(1): 52. CrossRef
Multiple drugs

Reactions Weekly.2021; 1881(1): 189. CrossRef

Original Articles

Predictors of Morbidity and Mortality After Surgery for Intestinal Perforation: Rumi Shin, Sang Mok Lee, Beonghoon Sohn, Dong Woon Lee, Inho Song, Young Jun Chai, Hae Won Lee, Hye Seong Ahn, In Mok Jung, Jung Kee Chung, Seung Chul Heo; Ann Coloproctol. 2016;32(6):221-227. Published online December 31, 2016; DOI: https://doi.org/10.3393/ac.2016.32.6.221

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33 Citations

Abstract PDF

Purpose

An intestinal perforation is a rare condition, but has a high mortality rate, even after immediate surgical intervention. The clinical predictors of postoperative morbidity and mortality are still not well established, so this study attempted to identify risk factors for postoperative morbidity and mortality after surgery for an intestinal perforation.

Methods

We retrospectively analyzed the cases of 117 patients who underwent surgery for an intestinal perforation at a single institution in Korea from November 2008 to June 2014. Factors related with postoperative mortality at 1 month and other postoperative complications were investigated.

Results

The mean age of enrolled patients was 66.0 ± 15.8 years and 66% of the patients were male. Fifteen patients (13%) died within 1 month after surgical treatment. Univariate analysis indicated that patient-related factors associated with mortality were low systolic and diastolic blood pressure, low serum albumin, low serum protein, low total cholesterol, and high blood urea nitrogen; the surgery-related factor associated with mortality was feculent ascites. Multivariate analysis using a logistic regression indicated that low systolic blood pressure and feculent ascites independently increased the risk for mortality; postoperative complications were more likely in both females and those with low estimated glomerular filtration rates and elevated serum C-reactive protein levels.

Conclusion

Various factors were associated with postoperative clinical outcomes of patients with an intestinal perforation. Morbidity and mortality following an intestinal perforation were greater in patients with unstable initial vital signs, poor nutritional status, and feculent ascites.

Citations

Citations to this article as recorded by

In Situ 4D Printing of Polyelectrolyte/Magnetic Composites for Sutureless Gastric Perforation Sealing
Yunsong Shi, Sihan Tang, Xi Yuan, Zhuofan Li, Shifeng Wen, Zhongwei Li, Bin Su, Chunze Yan, Lili Chen
Advanced Materials.2024;[Epub] CrossRef
Small Intestinal Perforation after 360-Degree Liposuction: A Case Report
Jenna C. Bekeny, Samuel S. Huffman, Chris Thomas, Mariana Tumminello, Anna Kata, Rajiv Parikh, Laura K. Tom, Grant M. Kleiber
Aesthetic Plastic Surgery.2024; 48(5): 946. CrossRef
Issues of informed consent for non-specialists conducting colorectal cancer screenings
Forrest Bohler, Allison Garden
Journal of Osteopathic Medicine.2024; 124(1): 39. CrossRef
Prevalence, Pattern, Mortality, and Morbidity of Traumatic Small Bowel Perforation at King Abdulaziz Medical City: A Retrospective Cohort Study
Fahad Aljehaiman, Faisal J Almalki, Abdulah Alhusain, Faris Alsalamah, Khaled Alzahrani, Abdulkareem Alharbi, Hani Alkhulaiwi
Cureus.2024;[Epub] CrossRef
Abdominal pain after a food crawl
Danier Ong, Rajiv Yogendran, Emily Fite
Journal of the American College of Emergency Physicians Open.2024;[Epub] CrossRef
Case of abdominal whirl sign with small bowel obstruction and free gas successfully managed by conservative management instead of laparoscopic surgery
Giuleta Jamsari, James Wei Tatt Toh
Laparoscopic, Endoscopic and Robotic Surgery.2024; 7(3): 128. CrossRef
Emergent Esophagectomy in Patients with Esophageal Malignancy Is Associated with Higher Rates of Perioperative Complications but No Independent Impact on Short-Term Mortality
Yahya Alwatari, Devon C. Freudenberger, Jad Khoraki, Lena Bless, Riley Payne, Walker A. Julliard, Rachit D. Shah, Carlos A. Puig
Journal of Chest Surgery.2024; 57(2): 160. CrossRef
Urea to Albumin Ratio Is an Excellent Predictor of Death in Patients With Complicated Intra-Abdominal Infections
Evgeni Dimitrov, Krasimira Halacheva, Georgi Minkov, Emil Enchev, Yovcho Yovtchev
Surgical Infections.2024; 25(3): 225. CrossRef
Postoperative Complications in Emergency Surgeries at a Referral Hospital in Eastern Venezuela
Victor Castañeda-Marquez, Yeisson Rivero-Moreno, Enrique Avila-Liendo, Gabriel Gonzalez-Quinde, Wilson Garcia-Cazorla, Georcimar Mendez-Meneses, Yoalkris E Salcedo, Tamara Rodriguez-Rugel, Jackner Antigua-Herrera, Miguel Rivas-Perez, Silvia Agudelo-Mendoz
Cureus.2024;[Epub] CrossRef
Gastrointestinal tract perforation after radiofrequency ablation for hepatic tumor: Incidence and risk factors
Kyowon Gu, Tae Wook Kang, Seungchul Han, Dong Ik Cha, Kyoung Doo Song, Min Woo Lee, Hyunchul Rhim, Go Eun Park
European Journal of Radiology.2024; 177: 111560. CrossRef
Revisiting Physiological and Operative Severity Score for the Enumeration of Mortality and Morbidity (POSSUM) and Portsmouth-POSSUM (P-POSSUM) Scores: Are They Valid in Cases of Ileal Perforation?
Saikrishna Eswaravaka, Chirantan Suhrid, Bhavya Rao, Sundaresh Prabhakar, Jayashri Pandya
Cureus.2024;[Epub] CrossRef
A giant trichobezoar in a child with attention deficit hyperactivity disorder: A case report
M. Forooghi, R. Shahrokhi, Sh. Yousufzai
International Journal of Surgery Case Reports.2024; 123: 110283. CrossRef
Factors related to cardiac rupture after acute myocardial infarction
Xue Gao, Ying Guo, Xiaoting Zhu, Chunlei Du, Beibei Ma, Yinghua Cui, Shuai Wang
Frontiers in Cardiovascular Medicine.2024;[Epub] CrossRef
Characteristics, treatment, and outcome of patients with bowel perforation after immune checkpoint inhibitor exposure
Antonio Pizuorno Machado, Malek Shatila, Cynthia Liu, Yang Lu, Mehmet Altan, Isabella C. Glitza Oliva, Dan Zhao, Hao Chi Zhang, Anusha Thomas, Yinghong Wang
Journal of Cancer Research and Clinical Oncology.2023; 149(9): 5989. CrossRef
Abdominal emergency surgery in patients with hematological malignancies: a retrospective single-center analysis
Philipp H. von Kroge, Anna Duprée, Oliver Mann, Jakob R. Izbicki, Jonas Wagner, Paymon Ahmadi, Sören Weidemann, Raissa Adjallé, Nicolaus Kröger, Carsten Bokemeyer, Walter Fiedler, Franziska Modemann, Susanne Ghandili
World Journal of Emergency Surgery.2023;[Epub] CrossRef
Acute Spontaneous Colonic Perforation in a Case of Newly Confirmed Scleroderma: Case Report
Glenn Goodwin, Christian Ryckeley, Davide Fox, Michael Ashley, Laurence Dubensky, Mauricio Danckers, Todd Slesinger
Interactive Journal of Medical Research.2023; 12: e43295. CrossRef
Surgical outcomes and prognostic factors associated with emergency left colonic surgery
Dauda Bawa, Yasser Mohammad Khalifa, Saleem Khan, Waddah Norah, Nibras Noman
Annals of Saudi Medicine.2023; 43(2): 97. CrossRef
Fatal Case of Perforated Cytomegalovirus Colitis: Case Report and Systematic Review
Andrea T. Fisher, Kovi E. Bessoff, Veronica Nicholas, James Badger, Lisa Knowlton, Joseph D. Forrester
Surgical Infections.2022; 23(2): 127. CrossRef
An adhesive and resilient hydrogel for the sealing and treatment of gastric perforation
Jing Chen, Julia S. Caserto, Ida Ang, Kaavian Shariati, James Webb, Bo Wang, Xi Wang, Nikolaos Bouklas, Minglin Ma
Bioactive Materials.2022; 14: 52. CrossRef
Predictors of mortality in patients with acute small-bowel perforation transferred to ICU after emergency surgery: a single-centre retrospective cohort study
Jianzhang Wu, Ping Shu, Hongyong He, Haojie Li, Zhaoqing Tang, Yihong Sun, Fenglin Liu
Gastroenterology Report.2022;[Epub] CrossRef
Delayed ileal perforation following lollipop-stick ingestion in a two year old
Tareq Swedan, Mohamed Morjan, Mulham Jarjanazi, Nafiza Martini, Alaa Aldin Ismail, Hebatullah Awad, Shamseh Benbash
Journal of Pediatric Surgery Case Reports.2022; 81: 102276. CrossRef
The Clinical Significance of Shock Index and GFR in the Differential Diagnosis of Perforated Appendicitis
Ferhat ÇAY, Ali DURAN
Journal of Contemporary Medicine.2022; 12(4): 504. CrossRef
The Impact of Delayed Surgical Care on Patient Outcomes With Alimentary Tract Perforation: Insight From a Low-Middle Income Country
Muhammad H Zafar, Taha A Zaka Ur Rehman, Muhammad Sohaib Khan, Shayan Ahmed, Amir Shariff
Cureus.2022;[Epub] CrossRef
Gangrene of the Colon Ascendens, Colon Transversum, and Lienal Flexure in a Massive Strangulated Umbilical Hernia
Stanko Baco, Milos Mitric
Cureus.2022;[Epub] CrossRef
Facility of Origin Predicts Mortality After Colonic Perforation
Samuel D. Butensky, Emma Gazzara, Gainosuke Sugiyama, Gene F. Coppa, Antonio Alfonso, Paul J. Chung
The American Surgeon™.2021; 87(8): 1327. CrossRef
Effect of Malnutrition Assessed by Comprehensive Nutritional Screening Tool on In-Hospital Mortality after Surgery for Gastrointestinal Perforation
Seung-Young Oh, Hannah Lee, Ho Geol Ryu, Hyuk-Joon Lee
Surgical Metabolism and Nutrition.2021; 12(1): 1. CrossRef
Machine Learning-based Model for Predicting Postoperative Complications among Patients with Colonic Perforation: A Retrospective study
Hiroka Hosaka, Masashi Takeuchi, Tomohiro Imoto, Haruka Yagishita, Ayaka Yu, Yusuke Maeda, Yosuke Kobayashi, Yoshie Kadota, Masanori Odaira, Fumiki Toriumi, Takashi Endo, Hirohisa Harada
Journal of the Anus, Rectum and Colon.2021; 5(3): 274. CrossRef
Bevacizumab and gastrointestinal perforations: a review from the FDA Adverse Event Reporting System (FAERS) database
Thomas A. Wichelmann, Sufyan Abdulmujeeb, Eli D. Ehrenpreis
Alimentary Pharmacology & Therapeutics.2021; 54(10): 1290. CrossRef
A Rare Presentation of Gastric Carcinoma With Gastric Perforation and Septic Shock
Reem Moala AlHazmi, Dunya Nasrallah Alfaraj, Shaykhah Nasser AlNaimi, Sarah Mohammed AlQahtani, Mashael Hamed AlJuwayed, Hazem Mohammed Zakriea, Mohammed S Foula
Cureus.2021;[Epub] CrossRef
C-Reactive Protein as a Marker of Postoperative Complication of Emergency Colorectal Surgery
Luis R. M. Nadal, Artur M. A. da Silva, Larissa Johann, Shuaib H. El Boustani, Maria Beatriz A. S. Medrado, Jose F. M. Farah, Renato A. Lupinacci
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Modified frailty index and hypoalbuminemia as predictors of adverse outcomes in older adults presenting to acute general surgical unit
Angela Abraham, Sally Burrows, Neelankal John Abraham, Bhaskar Mandal
Revista Española de Geriatría y Gerontología.2020; 55(2): 70. CrossRef
Prognostic Factors and Management for Left Colonic Perforation: Can Hartmann’s Procedure Be Preventable?
Yilseok Joo, Yujin Lee, Taeyoung Yoo, Jungbin Kim, Inseok Park, Geumhee Gwak, Hyunjin Cho, Keunho Yang, Kiwhan Kim, Byung-Noe Bae
Annals of Coloproctology.2020; 36(3): 178. CrossRef
Intestinal Perforation: A Surgeon's Nightmare Enlightened by Scientific Research
Byung Soh Min
Annals of Coloproctology.2016; 32(6): 205. CrossRef

Prompt Management Is Most Important for Colonic Perforation After Colonoscopy: Hyun-Ho Kim, Bong-Hyeon Kye, Hyung-Jin Kim, Hyeon-Min Cho; Ann Coloproctol. 2014;30(5):228-231. Published online October 28, 2014; DOI: https://doi.org/10.3393/ac.2014.30.5.228

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Abstract PDF

Purpose

The incidence of complications after colonoscopy is very low. The complications after colonoscopy that are of clinical concern are bleeding and perforation. The present study was conducted to determine the clinical outcomes and the risk factors of a colostomy or a colectomy after colonoscopic colon perforation.

Methods

From March 2009 to December 2012, the records of all patients who were treated for colorectal perforation after colonoscopy were reviewed retrospectively. The following parameters were evaluated: age, sex, purpose of colonoscopy, management of the colonic perforation, and interval from colonoscopy to the diagnosis of a colonic perforation. A retrospective analysis was performed to determine the risk factors associated with major surgery for the treatment of a colon perforation after colonoscopy.

Results

A total 27 patients were included in the present study. The mean age was 62 years, and 16 were males. The purpose of colonoscopy was diagnostic in 18 patients. The most common perforation site was the sigmoid colon. Colonic perforation was diagnosed during colonoscopy in 14 patients, just after colonoscopy in 5 patients, and 24 hours or more after colonoscopy in 8 patients. For the treatment of colonic perforation, endoscopic clipping was performed in 3 patients, primary closure in 15 patients, colon resection in 2 patients, Hartmann's procedures in 4 patients, and diverting colostomy in 3 patients. If the diagnosis of perforation after colonoscopy was delayed for more than 24 hours, the need for major treatment was increased significantly.

Conclusion

Although a colonic perforation after colonoscopy is rare, if the morbidity and the mortality associated with the colonic perforation are to be reduced, prompt diagnosis and management are very important.

Citations

Citations to this article as recorded by

Iatrogenic colon perforation during colonoscopy, diagnosis/treatment, and follow-up processes: A single-center experience
Nihat Gülaydın, Raim İliaz, Atakan Özkan, A Hande Gökçe, Hanifi Önalan, Berrin Önalan, Aziz Arı
Turkish Journal of Surgery.2022; 38(3): 221. CrossRef
Multicenter retrospective evaluation of ileocecocolic perforations associated with diagnostic lower gastrointestinal endoscopy in dogs and cats
Vanessa L. Woolhead, Jacqueline C. Whittemore, Sarah A. Stewart
Journal of Veterinary Internal Medicine.2020; 34(2): 684. CrossRef
Clinical Characteristics of Colonoscopic Perforation and Risk Factors for Complications After Surgical Treatment
Liang Li, Bing Xue, Chunxia Yang, Zhongbo Han, Hongqiang Xie, Meng Wang
Journal of Laparoendoscopic & Advanced Surgical Techniques.2020; 30(11): 1153. CrossRef
Treatment of colonoscopic perforation: outcomes from a major single tertiary institution
Carolyn R. Chew, Justin M. C. Yeung, Ian G. Faragher
ANZ Journal of Surgery.2019; 89(5): 546. CrossRef
Iatrogenic Colonic Perforations: Changing the Paradigm
Jose Luis Ulla-Rocha, Angel Salgado, Raquel Sardina, Raquel Souto, Raquel Sanchez-Santos, Juan Turnes
Surgical Laparoscopy, Endoscopy & Percutaneous Techniques.2019; 29(3): 173. CrossRef
Concurrent retroperitoneal, mediastinal, cervical and subcutaneous emphysema secondary to iatrogenic sigmoid colon perforation
Zehui Wu, Huaping Xu, Yisheng Zhang, Lianghui Shi
Postgraduate Medical Journal.2019; 95(1125): 396. CrossRef
Management of colonoscopic perforations: A systematic review
Alexander T. Hawkins, Kenneth W. Sharp, Molly M. Ford, Roberta L. Muldoon, M. Benjamin Hopkins, Timothy M. Geiger
The American Journal of Surgery.2018; 215(4): 712. CrossRef
2017 WSES guidelines for the management of iatrogenic colonoscopy perforation
Nicola de’Angelis, Salomone Di Saverio, Osvaldo Chiara, Massimo Sartelli, Aleix Martínez-Pérez, Franca Patrizi, Dieter G. Weber, Luca Ansaloni, Walter Biffl, Offir Ben-Ishay, Miklosh Bala, Francesco Brunetti, Federica Gaiani, Solafah Abdalla, Aurelien Ami
World Journal of Emergency Surgery.2018;[Epub] CrossRef
Management Outcomes of Colonoscopic Perforations Are Affected by the General Condition of the Patients
Jae Ho Park, Kyung Jong Kim
Annals of Coloproctology.2018; 34(1): 16. CrossRef
Managing a Colonoscopic Perforation in a Patient with No Abdominal Wall
Jayan George, Michael Peirson, Samuel Birks, Paul Skinner
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Air and its Sonographic Appearance: Understanding the Artifacts
Simran Buttar, Denrick Cooper, Patrick Olivieri, Michael Barca, Aaran B. Drake, Melvin Ku, Gabriel Rose, Sebastian D. Siadecki, Turandot Saul
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Colonoscopic Perforations, What is Our Experience in a Training Hospital?
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Endoscopic Therapy in Crohnʼs Disease
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Importance of Prompt Diagnosis in the Management of Colonoscopic Perforation
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Case Reports

Transanal Evisceration Caused by Rectal Laceration: Aleix Martínez Pérez, María Teresa Torres Sánchez, Jose Manuel Richart Aznar, Eva María Martí Martínez, Manuel Martínez-Abad; Ann Coloproctol. 2014;30(1):47-49. Published online February 28, 2014; DOI: https://doi.org/10.3393/ac.2014.30.1.47

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Transrectal evisceration caused by colorectal injury is an unusual entity. This pathology is more frequent in elderly patients and it is usually produced spontaneously. Rectal prolapse is the principal predisposing factor. An 81-year-old woman was taken to the hospital presenting exit of intestinal loops through the anus. After first reanimation measures, an urgent surgery was indicated. We observed the absence of almost every small intestine loop in the abdominal cavity; these had been moved to the pelvis. After doing the reduction, a 3 to 4 cm linear craniocaudal perforation in upper rectum was objectified, and Hartmann's procedure was performed. We investigated and knew that she frequently manipulate herself to extract her faeces. The fast preoperative management avoided a fatal conclusion or an extensive intestinal resection. Reasons that make us consider rectal self-injury as the etiologic factor are explained.

Citations

Citations to this article as recorded by

Transanal evisceration of small bowel in two patients with chronic rectal prolapse: case presentation and literature review
S Hajiev, A Ezzat, V Sivarajah, G Reese, N El-Masry
The Annals of The Royal College of Surgeons of England.2021; 103(1): e29. CrossRef
Evisceración de asas intestinales a través de periné posterior por traumatismo en paciente anciano
Ana Alicia Tejera Hernández, David Fernández San Millan, Carlos David Trujillo Flores, Juan Ramón Hernández Hernández
Revista Española de Geriatría y Gerontología.2016; 51(1): 58. CrossRef
Transanal Evisceration of Small Bowel about One Case at the University Hospital Yalgado Ouédraogo of Ouagadougou
Adama Sanou, Moussa Bazongo, Edgar Ouangré, Maurice Zida, Gilbert Patindé Bonkoungou, Rodrique Namékinsba Doamba, Sylvain Wendmi Karfo, Elie Yamba Sawadogo, Nayi Zongo, Si Simon Traoré
Surgical Science.2016; 07(07): 291. CrossRef

Rectal Perforation Caused by Anal Stricture After Hemorrhoid Treatment: Yong Joon Suh, Heon-Kyun Ha, Heung-Kwon Oh, Rumi Shin, Seung-Yong Jeong, Kyu Joo Park; Ann Coloproctol. 2013;29(1):28-30. Published online February 28, 2013; DOI: https://doi.org/10.3393/ac.2013.29.1.28

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Abstract PDF

Inappropriate therapies for hemorrhoids can lead to various complications including anorectal stricture. We report a patient presenting with catastrophic rectal perforation due to severe anal stricture after inappropriate hemorrhoid treatment. A 67-years old man with perianal pain visited the emergency room. The hemorrhoids accompanied by constipation, had tortured him since his youth. Thus he had undergone injection sclerotherapy several times by an unlicensed therapist and hemorrhoidectomy twice at the clinics of private practitioners. His body temperature was as high as 38.5℃. The computed tomographic scan showed a focal perforation of posterior rectal wall. The emergency operation was performed. The fibrotic tissues of the anal canal were excised. And then a sigmoid loop colostomy was constructed. The patient was discharged four days following the operation. This report calls attention to the enormous risk of unlicensed injection sclerotherapy and overzealous hemorrhoidectomy resulting in scarring, progressive stricture, and eventual rectal perforation.

Citations

Citations to this article as recorded by

Laser hemorrhoidoplasty for hemorrhoidal disease: a systematic review and meta-analysis
Hendry Lie, Evelyn Franca Caesarini, Antonius Agung Purnama, Andry Irawan, Taufik Sudirman, Wifanto Saditya Jeo, Bernardus Parish Budiono, Erik Prabowo, M. Iqbal Rivai, Ryanto Karobuana Sitepu
Lasers in Medical Science.2022; 37(9): 3621. CrossRef

Ischemic Pseudomembranous Colitis with Perforation due to Polyarteritis Nodosa.: Kim, Ki Nam; J Korean Soc Coloproctol. 2004;20(3):176-179.

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Abstract PDF: Polyarteritis nodosa, one of the necrotizing vasculitis involving predominantly small and medium sized arteries is a rare disease. Gastrointestinal involvements have been reported in more than 50% of patients at some time during its course. The small bowel is the frequent site of involvement in clinically apparent ischemic disease. The colon is less commonly involved, particularly at the initial presentation. We report a rare case of polyarteritis nodosa with ischemic colitis, perforation, and pseudomembrane formation.

The Conservative Treatment of Rectal Perforation after Insertion of A Stent and Chemo-Radiotherephy in the Patient with Obstructive Rectal Cancer.: Jung, Jai Hun , Kim, Seog Mo , Kim, Cheong Yong , Ko, Kang Seog; J Korean Soc Coloproctol. 2000;16(1):41-46.

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Abstract PDF: The use of self-expanding metal stent has been widely reported that its utility can make a palliative decompression treatment and one stage operation without doing colostomy in the patient with unresectable and resectable obstructive colorectal cancer, respectively. It, however, can sometimes cause complications such as intestinal perforation. We report that the conservative treantment could be possible without removing stent or performing laparotomy in case of intestinal perforation during chemoradiotheraphy after insert of stent for relieving colonic obstruction in the 53 years old female patient with stage IV rectal cancer.

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