Techniques in Coloproctology

, Volume 20, Issue 2, pp 109–115 | Cite as

Global audit on bowel perforations related to transanal irrigation

  • P. ChristensenEmail author
  • K. Krogh
  • B. Perrouin-Verbe
  • D. Leder
  • G. Bazzocchi
  • B. Petersen Jakobsen
  • A. V. Emmanuel
Original Article



Transanal irrigation is increasingly used against chronic constipation and fecal incontinence in selected patients. The aims were to estimate the incidence of irrigation-related bowel perforation in patients using the Peristeen Anal Irrigation® system, and to explore patient- and procedure-related factors associated with perforation.


External independent expert audit on the complete set of global vigilance data related to Peristeen Anal Irrigation from 2005 to 2013.


In total, 49 reports of bowel perforation had been recorded. Based on sales figures, this corresponds to an average risk of bowel perforation of 6 per million procedures. The latest two-year data indicate a risk of 2 per million procedures. In 29 out of 43 evaluable cases (67 %), perforation happened within the first 8 weeks since start of treatment. After 8 weeks, long-term use has an estimated risk of less than 2 per million procedures. Among patients with non-neurogenic bowel dysfunction, 11 out of 15 (73 %) had a history of pelvic organ surgery compared to 5 out of 26 (19 %) in neurogenic bowel dysfunction. In 11 of 46 (24 %) evaluable cases, burst of the rectal balloon was reported.


Enema-induced perforation is a rare complication to transanal irrigation with Peristeen Anal Irrigation, which increases the benefit risk ratio in support of the further use of transanal irrigation. Increased risk is present during treatment initiation and in patients with prior pelvic organ surgery. Careful patient selection, patient evaluation and proper training of patients are critical to safe practice of this technique.


Functional GI diseases Large intestine Constipation Outcomes research Surgery Devices 



The study has not been financially supported.

Compliance with ethical standards

Conflicts of interest

Peter Christensen has served as a consultant and an advisory board member for Coloplast, and as an advisory board member for Wellspect Health Care. Klaus Krogh has served as an advisory board member for Coloplast and Wellspect Health Care. Brigitte Perrouin-Verbe has served as an advisory board member for Coloplast. Dietrich Leder has served as an advisory board member for Coloplast and Wellspect Health Care. Gabriele Bazzocchi has served as an advisory board member for Coloplast and Wellspect Health Care. Birte Petersen Jakobsen is an employee of Coloplast. Anton Emmanuel has served as a speaker, a consultant and an advisory board member for Coloplast, Hollister and Wellspect Health Care.

Ethical approval

This article does not contain any studies with human participants or animals performed by any of the authors.

Informed consent

For this type of study formal consent is not required.


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Copyright information

© Springer-Verlag Italia Srl 2015

Authors and Affiliations

  • P. Christensen
    • 1
    Email author
  • K. Krogh
    • 2
  • B. Perrouin-Verbe
    • 3
  • D. Leder
    • 4
  • G. Bazzocchi
    • 5
  • B. Petersen Jakobsen
    • 6
  • A. V. Emmanuel
    • 7
  1. 1.Pelvic Floor Unit, Department of SurgeryAarhus University HospitalAarhusDenmark
  2. 2.Department of Hepatology and GastroenterologyAarhus University HospitalAarhusDenmark
  3. 3.University Hospital of NantesSt Jacques HospitalNantesFrance
  4. 4.Chirurgische Klinik, BeckenbodenzentrumMunichGermany
  5. 5.Montecatone Rehabilitation InstituteUniversity of BolognaBolognaItaly
  6. 6.Coloplast A/SHumlebækDenmark
  7. 7.Department of GI PhysiologyUniversity College LondonLondonUK

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