A Case Report of Rectal Perforation Caused by a Female Forearm Inserted into the Anus During Sexual Relations

Abstract

A 63-year-old man came to our emergency department with a chief complaint of abdominal pain 30 hours after having a woman’s forearm inserted through his anus a distance of 30 cm at a brothel. Rectal perforation was suspected from the medical interview and contrast-enhanced CT examination, and an emergency laparotomy was performed 38 hours after the sexual relations. Only a small amount of bloody ascites was observed in the rectovesical pouch, and the inflammation was relatively mild. A perforation 1 cm in diameter was identified in the rectosigmoid, and it was closed with Albert-Lembert sutures. A sigmoid colostomy with double orifices was also constructed. The patient experienced temporary postoperative paralytic ileus and was discharged on the postoperative day 13. Patients with a rectal perforation caused by sexual relations may not accurately describe the episode because of embarrassment, but a detailed history taking can contribute to making an accurate diagnosis and prompt therapeutic intervention.