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Diseases of the Colon & Rectum

, Volume 42, Issue 12, pp 1609–1612 | Cite as

Enema-induced perforation of the rectum in chronically constipated patients

  • Haim Paran
  • Gavriel Butnaru
  • David Neufeld
  • Amalia Magen
  • Uri Freund
Original Contributions

Abstract

INTRODUCTION: The use of retrograde irrigation enemas is common in the treatment of chronic constipation, especially in the elderly. Perforation of the rectum and sigmoid colon caused by cleansing enemas, used by chronically constipated patients, has not been previously described. METHODS: We reviewed all patients with colorectal perforations caused by irrigation enemas admitted to our service in the three-year period between January 1995 and December 1997. RESULTS: Thirteen patients were treated by our surgical service because of perforations of the rectum and sigmoid colon related to a previous retrograde irrigation enema. Ten of these patients came from nursing homes, and the other three lived at home. The relevant information relating the enema administration to the patient's condition was given in only two of the ten patients referred to the emergency room by the institution's nursing or medical staff. In the other eight the information was vague and sometimes misleading. The diagnosis of colorectal performation was made by history, plain abdominal x-rays, and CT scan with or without meglumine diatrizoate enemas. Ten patients survived, regardless of age, previous diseases, or operative findings. In all of them, diagnosis was made within 36 hours from the perforation. The three deaths occurred in patients in whom the diagnosis was made late. CONCLUSIONS: Awareness of the possible injury from enemas administered to chronically constipated patients should be stressed. A high degree of suspicion by the attending physician is extremely important, because prompt diagnosis and early surgical treatment carries a relatively good prognosis.

Key words

Constipation Performation Enema Rectum 

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References

  1. 1.
    Harari D, Gurwitz JH, Avorn J, Choodnovskiy I, Minaker KL. Constipation: assessment and management in an institutionalized elderly population. J Am Geriatr Soc 1994;42:947–52.Google Scholar
  2. 2.
    Harari D, Gurwitz JH, Minaker KL. Constipation in the elderly. J Am Geriatr Soc 1993;41:1130–40.Google Scholar
  3. 3.
    Gedebou TM, Wong RA, Rappaport WD, Jaffe P, Kahsai D, Hunter GC. Clinical presentation and management of iatrogenic colon perforations. Am J Surg 1996;172:454–458.Google Scholar
  4. 4.
    Himmelman RG, Martin M, Gilkey S, Barret JA. Triple contrast CT scans in penetrating back and flank trauma. J Trauma 1991;31:852–5.Google Scholar
  5. 5.
    Miller BJ, Schache DJ. Colorectal injury: where do we stand with repair? Aust N Z J Surg 1996;66:348–52.Google Scholar
  6. 6.
    Shiels WE, Kirks DR, Keller GL,et al. Colonic perforation by air and liquid enemas: comparison study in young pigs. Am J Roentgenol 1993;160:931–5.Google Scholar
  7. 7.
    Shoji BT, Becker JM. Colorectal disease in the elderly patient. Surg Clin North Am 1994;74:293–316.Google Scholar
  8. 8.
    Hill J, Stott S, MacLennan I. Antegrade enemas for the treatment of severe idiopathic constipation. Br J Surg 1995;81:1490–1.Google Scholar
  9. 9.
    Briel JW, Schouten WR, Volt EA, Smits S, van Kessel I. Clinical value of colonic irrigation in patients with continence disturbances. Dis Colon Rectum 1997;40:802–5.Google Scholar
  10. 10.
    Ernst E. Colonic irrigation and the theory of autointoxication: a triumph of ignorance over science [editorial]. J Clin Gastroenterol 1997;24:196–8.Google Scholar

Copyright information

© The American Society of Colon & Rectal Surgeons 1999

Authors and Affiliations

  • Haim Paran
    • 1
  • Gavriel Butnaru
    • 1
  • David Neufeld
    • 1
  • Amalia Magen
    • 1
  • Uri Freund
    • 1
  1. 1.From the Department of Surgery “A”Meir HospitalKfar-SavaIsrael

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