Abstract
We experienced a case of rectal perforation without signs of peritonitis because the retroperitoneal space was penetrated. An 87-year-old woman was admitted to our hospital on August 28, 2003 because of lower abdominal pain and tarry stools. She had no fever or leukocytosis, and a physical examination showed no peritoneal signs. However, an abdominal CT scan on August 30, 2003 revealed retroperitoneal emphysema. We suspected perforation of the rectum and so performed an emergency operation. Solid stools were found not in the free cavity but in the retroperitoneal space near the rectum, so a low anterior resection was undertaken. When colorectal perforation affects the mesocolon or petroperitoneum, a confident diagnosis is difficult. However, an abdominal CT scan is useful for a diagnosis of retroperitoneal emphysema.
