A Case of Rectal Perforation After an Enema Caused by Segmental Absence of the Intestinal Musculature

Abstract

An 89-year-old female presented to another clinic complaining of abdominal pain and was given an enema to treat constipation. After the enema, she complained of severe abdominal pain after returning home, went back to the clinic, which transferred her to our hospital because of decreased blood pressure. At the first examination at our hospital, tenderness and rebound tenderness of the entire abdomen was noted. Blood examination revealed elevated levels of inflammatory markers. Abdominal computed tomography showed free air in the abdominal cavity and retroperitoneum, and fluid collection in the pelvic floor extending to the intrarectal space, findings suggestive of rectal perforation. Emergency laparotomy revealed a large amount of dirty ascites and a perforation on the right side of rectum. Partial resection of the rectum involving the perforation site, abdominal drainage, and colostomy were performed. Histopathological examination of the resected rectum showed segmental absence of the intestinal musculature（SAIM）. The rapid increase in rectal pressure during the enema may have affected the fragile part of the bowel lacking the intestinal muscularis, causing perforation.