Katano Kaoru, Furutani Yuichiro, Hiranuma Chikashi, Hattori Masakazu, Doden Kenji, Hashidume Yasuo
Department of Surgery, Fukui Prefectural Hospital, 2-8-1, Yotsui, Fukui, Fukui, 910-8526, Japan.
Int J Surg Case Rep. 2020;77:36-38. doi: 10.1016/j.ijscr.2020.10.101. Epub 2020 Oct 24.
Enema examination is considered safe, but in rare cases, complications may result. Here, we report a rare case of iatrogenic bowel perforation during enema examination through a colostomy without leakage of contrast agent.
A 36-year-old man who had undergone a sigmoid loop colostomy was diagnosed with ulcerative colitis. A bowel enema through a colostomy was performed by nurses and radiological technologists. During the procedure, a balloon catheter was inserted into the proximal lumen of the colostomy, and the balloon was inflated. The patient developed severe abdominal pain a few minutes following withdrawal of the catheter. Computed tomography showed intraperitoneal free air, although contrast agent leakage into the intraperitoneal cavity was not observed. The patient underwent emergency laparotomy. Intraoperatively, there was a 3-cm bowel perforation just inside the colostomy where the inflated balloon was pressing.
The perforation site may have been sealed by the inflated balloon during the enema examination. In addition, the patient maintained a supine position during and after the examination. This led to contrast agent accumulating on the dorsal side and not leaking out from the perforation site after the balloon was deflated.
Iatrogenic bowel perforation can occur without leakage of contrast agent during enema examination through a colostomy, and the examination should be performed under the supervision of an attending doctor. In the case of an enema examination through a colostomy, clinicians must be aware of the possibility of bowel perforation even if leakage of contrast agent is not observed.
灌肠检查被认为是安全的，但在极少数情况下可能会出现并发症。在此，我们报告一例罕见的经结肠造口进行灌肠检查时发生医源性肠穿孔且造影剂未渗漏的病例。
一名36岁男性，曾行乙状结肠袢式造口术，被诊断为溃疡性结肠炎。护士和放射技师通过结肠造口进行了灌肠。在操作过程中，将球囊导管插入结肠造口的近端管腔并充盈球囊。导管拔出几分钟后患者出现严重腹痛。计算机断层扫描显示腹腔内有游离气体，尽管未观察到造影剂漏入腹腔。患者接受了急诊剖腹手术。术中发现，在结肠造口内刚好被充盈球囊压迫的部位有一个3厘米的肠穿孔。
在灌肠检查过程中，穿孔部位可能被充盈的球囊封闭。此外，患者在检查期间及之后均保持仰卧位。这导致造影剂积聚在背侧，球囊放气后造影剂未从穿孔部位漏出。
经结肠造口进行灌肠检查时，即使造影剂未渗漏也可能发生医源性肠穿孔，该检查应在主治医生的监督下进行。对于经结肠造口的灌肠检查，临床医生即使未观察到造影剂渗漏，也必须意识到肠穿孔的可能性。
