Traumatic Rectal Perforation Mimicking a Perforated Duodenal Ulcer: A Hidden Injury-associated Mechanism

Abstract

Patients who present with transanal foreign body insertion often do not provide precise information. A male in his fifties with a history of duodenal ulcer was brought to our hospital by ambulance for epigastric pain after meals. Abdominal computed tomography (CT) showed free air around the duodenum and massive ascites. We initially considered that the patient was presenting with a perforated duodenal ulcer. However, fresh blood on the rectal examination and high CT attenuation values of the ascites led us to suspect traumatic lower gastrointestinal perforation. Finally, privacy-conscious history taking revealed a hidden mechanism of injury caused by the patient’s male partner having inserted his hand and arm into the patient’s rectum. A Hartmann’s procedure was performed and revealed a rectosigmoid perforation with a seromuscular laceration of the lower sigmoid colon. This case mimicked a perforated duodenal ulcer. A hidden mechanism of injury is important for the preoperative diagnosis of a perforation site.