Major rectal perforations caused by enema: is surgery mandatory?

Abstract

Background: Current methods of large bowel preparation prior to colonoscopy, barium enema and surgery are extremely effective in cleaning the bowel of feces. We rationalize, therefore, that under these conditions rectal perforations secondary to barium and cleansing enema could be treated expectantly, namely either defer or completely avoid immediate surgery.

Patients: Two female patients with major rectal perforations secondary to barium and cleansing enema who had thoroughly prepared large bowel were treated conservatively.

Results: Both patients did well without surgery and were discharged without any long-term sequela.

Conclusion: Since a large number of iatrogenic perforations of the rectum occur in patients with well-prepared and clean bowel immediate surgery can be deferred or avoided all together without compromising them.