Gallo Gaetano, Clerico Giuseppe, Tutino Roberta, De Luca Emilia, Luc Alberto Realis, Trompetto Mario
Ann Ital Chir. 2016 Nov 28;87:S2239253X1602644X.
Defecography is the standard diagnostic technique for the diagnosis of functional disorders of the posterior pelvic compartment. However it has some limits as radiation exposure, low-contrast resolution, some degrees of embarrassment and discomfort for the patients. Furthermore it often fails to directly visualize the changes that affect the pararectal space. Here we present a never described case of rectal perforation after defecography with barium impaction removed by TEM (Transanal Endoscopic Microsurgery).
We present a case of a 50 years old woman with extraluminal barium impaction due to perforation occurred during defecography. Both pelvic MR and endoanal ultrasound confirmed the presence of the extramural rectal mass below rectal mucosa. It was completely and safely removed using transanal endoscopic microsurgery (TEM).
The barium impaction has been radically removed using transanal endoscopic microsurgery. The post-operative period was uneventful and the patient was discharged 3 days after the operation. She is asymptomatic after 6 months from surgery.
Defecography is not completely safe and its use must be indicated only in selected cases. When a patient has complications during or after this investigation he must be referred to a specialistic centre where a tailored treatment can be performed. It is mandatory that the indication for defecography and other diagnostic functional investigations is given by a colorectal specialist KEY WORD: Barium Impaction, Defecography, Rectal Perforation, TEM (Transanal Endoscopic Microsurgery).
排粪造影是诊断盆腔后段功能性疾病的标准诊断技术。然而，它存在一些局限性，如辐射暴露、低对比度分辨率、给患者带来一定程度的尴尬和不适。此外，它常常无法直接观察到影响直肠旁间隙的变化。在此，我们报告一例排粪造影后直肠穿孔伴钡剂嵌塞的病例，通过经肛门内镜显微手术（TEM）取出了钡剂。
我们呈现了一名50岁女性的病例，她因排粪造影时发生穿孔而出现管腔外钡剂嵌塞。盆腔磁共振成像（MR）和肛门内超声均证实直肠黏膜下方存在壁外直肠肿物。通过经肛门内镜显微手术（TEM）将其完全安全地切除。
经肛门内镜显微手术已将钡剂嵌塞彻底清除。术后恢复顺利，患者术后3天出院。术后6个月她无症状。
排粪造影并非完全安全，其应用必须仅在特定病例中进行。当患者在此检查期间或之后出现并发症时，必须转诊至专科中心，以便进行针对性治疗。排粪造影及其他诊断性功能检查的指征必须由结直肠专科医生给出。关键词：钡剂嵌塞、排粪造影、直肠穿孔、经肛门内镜显微手术（TEM）
