A case of idiopathic rectal perforation in a young patient

Abstract

A 32-year-old male patient presented with bloody stool after constipation for 5 days. He was diagnosed with proctitis by colonoscopy but pathological examination revealed only non-specific inflammatory changes. The bloody stool improved with conservative management and inflammatory reaction returned to normal. Two weeks later, colonoscopy and CT scan revealed rectal perforation and a false lumen in the rectum below the peritoneal reflection. The patient had no history of trauma or rectal insertion of foreign materials. The mechanism of perforation was not apparent but factors such as primary colonoscopy or biopsy, repeated straining, obesity, prolonged sitting occupationally as a bus driver, and/or chronic circulatory deficiency of the rectum wall due to poorly controlled diabetes may have contributed to formation of the rectal perforation. The patient improved slowly with conservative management and surgery was not necessary.