Sozutek Alper, Tas Ekin Y, Yener Kemal, Ozcomert Julia
Gastroenterological Surgery, Health Sciences University, Adana City Training and Research Hospital, Adana, TUR.
Gastroenterological Surgery, Health Sciences University, Adana City Training and Research Hospital, Adana , TUR.
Cureus. 2023 Mar 9;15(3):e35939. doi: 10.7759/cureus.35939. eCollection 2023 Mar.
Traumatic rectal injuries (TRIs) are challenging for surgeons because of their high morbidity and mortality. Considering the well-known predisposing factors, enema-associated rectal perforation seems to be the most overlooked entity that leads to devastating rectal injuries. A 61-year-old man with a three-day history of painful swelling around his perirectal area after enema application was referred to the outpatient clinic. CT demonstrated the presence of a left posterolateral rectal abscess compatible with an extraperitoneal rectal injury. Sigmoidoscopy revealed the perforation started 2 cm above the dentate line with a diameter of 10 cm and a depth of 3 cm. Endoluminal vacuum therapy (EVT) and laparoscopic sigmoid loop colostomy was performed. The patient was discharged after removing the system on postoperative Day 10. On his follow-up, the perforation side was totally closed and pelvic abscess was completely resolved two weeks after his discharge. EVT appears to be a simple, safe, well-tolerated and cost-effective therapeutic procedure in the management of delayed extraperitoneal rectal perforations (ERPs) with large defects. To our knowledge, this is the first case that reveals the potency of EVT in the management of a delayed rectal perforation associated with an uncommon entity.
创伤性直肠损伤（TRIs）因其高发病率和死亡率，对外科医生来说是一项挑战。考虑到众所周知的诱发因素，灌肠相关的直肠穿孔似乎是最容易被忽视的导致严重直肠损伤的病因。一名61岁男性在灌肠后肛周区域疼痛肿胀三天，被转诊至门诊。CT显示左后外侧直肠脓肿，符合腹膜外直肠损伤。乙状结肠镜检查发现穿孔始于齿状线以上2 cm，直径10 cm，深度3 cm。进行了腔内负压治疗（EVT）和腹腔镜乙状结肠袢式造口术。术后第10天拆除系统后患者出院。随访时，穿孔部位完全闭合，出院两周后盆腔脓肿完全消退。对于伴有大缺损的延迟性腹膜外直肠穿孔（ERPs）的治疗，EVT似乎是一种简单、安全、耐受性良好且具有成本效益的治疗方法。据我们所知，这是首例揭示EVT在处理与罕见病因相关的延迟性直肠穿孔方面有效性的病例。
