A Case of Fecal Penetration Into the Mesentery

Abstract

We report a rare of fecal penetration from the rectum into the mesentery. A female in her 60’s presented with acute left lower abdominal pain. She had a history of severe constipation. Physical examination revealed tenderness of the left lower abdomen, but no rebound tenderness. Abdominal computed tomography (CT) demonstrated only hard stools in the entire colon, therefore, conservative treatment was initiated. The following morning, abdominal examination revealed rebound tenderness of the middle and lower abdomen and elevation of the blood markers of inflammation. Abdominal contrast CT revealed free gas along the branch of the lower mesenteric artery at the periphery of the rectum. Rectal perforation was diagnosed and emergency surgery was performed. Hard stools filled the entire large intestine and fecal accumulation in the mesenchyme was confirmed. The sigmoid colon was excised up to the upper rectum and the large intestine was emptied of the hard stools to the extent possible and a colostomy constructed. In the resected specimen, a 22 × 14 mm oval perforation was noted on the mesenteric side of the upper rectum, confirming the diagnosis of fecal rectal penetration into the mesentery.