A Case of Idiopathic Rectal Perforation without Peritoneal Sign

Eiji Meguro, Toshimoto Kimura, Takashi Irinoda, Yoshiroh Hayakawa, Makoto Kobayashi and Akinori Takagane

Department of Surgery, Hakodate Goryoukaku Hospital

The patient was a 32-year-old female with abdominal pain. Abdominal X-ray and CT clearly demonstrated free gas in the abdominal cavity. While the patient reported mild spontaneous pain neither muscular guarding nor sigh of peritoneal irritation were detected by palpation. Since there were no sign of peritoneal irritation, idiopathic pneumoperitoneum and cystic emphysema of the intestine were suspected, however, we performed diagnostic laparotomy because perforation of the digestive tract could not be excluded. The patient was diagnosed as having rectal perforation based on the presence of pus on the serous membrane and mesenteric hematoma in the rectum (Rs), and laparotomy was performed. Since the peritonitis was localized, and edema and inflammation of the wall of the rectum were very mild, we simultaneously performed anterior excision in the low position and drainage after sufficient rinsing of the abdominal cavity. The postoperative course was good, and the patient was discharged from the hospital 11 days after the surgery. Idiopathic perforation and rupture of the large intestine are most often observed in the sigmoid colon (70-80%), and is rare in the rectum. However, perforation of the rectum causes high invasion and severe inflammatory symptoms, and the patients often develop septic shock. Therefore, the postoperative outcome is generally poor in these cases.

Key words
rectal perforation without peritonitis symptoms, idiopathic rectal perforation

Reprint requests
Eiji Meguro Department of Surgery, Hakodate Goryoukaku Hospital
38-3 Goryoukakucho, Hakodate, 040-8611 JAPAN

Accepted
December 15, 2006

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