A Report of Spontaneous Rectal Rupture Successfully Treated by Emergent Operation

Yuki Sekine, Ryogo Ichinose, Tatsuya Fukumori, Yu Suzuki, Yoshihiro Endo and Michihiko Kitamura

Department of Surgery, Iwate Prefectural Isawa Hospital

A 63-year-old man reporting sudden onset of severe abdominal pain was found on physical examination to show boardy stiffness, severe tenderness, and muscular defense in the lower abdomen. A diagnosis of peritonitis led to emergency surgery. Exploration showed extensive coagulation, stool covered with mesenterium, and a 10-cm fissure at the middle and lower rectal wall, so we conducted Hartmann's operation. Postoperatively, the man suffered from decreased white blood cell and platelet counts and increased heart rate and oliguria. Intensive care including endotoxin absorption therapy, mechanical ventilation support, and blood transfusion, improved his condition. An idiopathic perforation of the colon was defined as the occurrence in the absence of carcinoma, diverticulum, foreign bodies, inflammatory bowel disease, and iatrogenic agents. The most common site of idiopathic perforation of the large intestine is sigmoid colon (70∼80%). Idiopathic perforation of the rectum is rare (5∼10%). The site of such a perforation is typically the anterior wall just proximal to the peritoneal reflection, so closure of the anal site of the rectum is difficult. It is difficult to correctly preoperatively diagnose colon perforation. Due to the systemic inflammatory response, the postoperative course of this disease is eventful and intensive care is mandatory.

Key words
spontaneous rupture (perforation) of rectum, endotoxin absorption therapy

Reprint requests
Yuki Sekine Department of Surgery, Iwate Prefectural Isawa Hospital 61 Ryugababa, Mizusawa-city, 023-0846 JAPAN

Accepted
July 31, 2001

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