1887
Volume 2021, Issue 1
  • ISSN: 0253-8253
  • EISSN: 2227-0426

Abstract

Introduction: Constipation is a common complaint. The elderly are five times more prone to constipation than young people because of the effects of medication, immobility, and a blunted urge to defecate. Many of these patients are demented, have cognitive deficits, or suffer from a psychiatric disorder.

Colonic perforation caused by hydrostatic pressure is rare, and this typically occurs during fluoroscopic studies resulting when there is excessive intraluminal colonic pressure. Self-induced colonic perforation is even rarer.

Case report: We report the case of a 95-year-old man who presented to the emergency department with an acute surgical abdomen and symptoms of sepsis. He had a history of longstanding constipation. He gave a history of frequent insertion of a rubber hose into his anal canal to relieve his constipation while rinsing his anus after defecation. After resuscitation, an emergency operation was performed, and sigmoid colon perforation was found in addition to pre-existing diverticular disease. Hartmann’s procedure was performed after abdominal washout. Unfortunately, the patient died of multi-organ failure two days after surgery.

Conclusion: Self-induced hydrostatic colonic perforation is rare. The consequence is fatal, especially in the elderly or in cases of delayed presentation.

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2021-04-26
2021-10-17
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References

  1. Bramson RT, Blickman JG Perforation during hydrostatic reduction of intussusception: proposed mechanism and review of the literature. J Pediatr Surg. 1992;27:589–91.
    [Google Scholar]
  2. Walking A. Rupture of the sigmoid by hydrostatic pressure. Ann Surg. 1935;102:471–2.
    [Google Scholar]
  3. Choi PW. Colorectal perforation by self-induced hydrostatic pressure: a report of two cases. J Emer Med. 2013;44:344–48.
    [Google Scholar]
  4. Niv Y, Galia Niv, Tamar Grinberg, Nir Waserberg, Ram Dickman. Perforation and mortality after cleansing enema for acute constipation are not rare but are preventable. Int J Gen Med. 2013;6:323–8.
    [Google Scholar]
  5. Fry RD, Shemesh EI, Kodner IJ, Fleshman JW, Timmcke AE. Perforation of the rectum and sigmoid colon during barium-enema examination. Management and prevention. Dis Colon Rectum. 1989;32:759–64.
    [Google Scholar]
  6. Waye JD, Kahn O, Auerbach ME. Complications of colonoscopy and flexible sigmoidoscopy. Gastrointest Endosc Clin N Am. 1996;6:343–77.
    [Google Scholar]
  7. Khan JS, Moran BJ. Iatrogenic perforation at colonic imaging. Colorectal Dis. 2011;13:481–93.
    [Google Scholar]
  8. Handley DV, Rieger NA, Rodda DJ. Rectal perforation from colonic irrigation administered by alternative practitioners. Med J Aust.2004;181:575–76.
    [Google Scholar]
  9. Paran H, Butnaru G, Neufeld D, Magen A, Freund U. Enema-induced perforation of the rectum in chronically constipated patients. Dis Colon Rectum. 1999;42:1609–12.
    [Google Scholar]
  10. Nakamura H, Iyoda M, Sato K, Kitazawa K. Retrograde hydrostatic irrigation enema-induced perforation of the sigmoid colon in a chronic renal failure patient before colonoscopy. J Int Med Res. 2005;33:707–10.
    [Google Scholar]
  11. Kozarek RA, Earnest DL, Silverstein ME, Smith RG. Air pressure-induced colon injury during diagnostic colonoscopy. Gastroenterology. 1980;78:7–14.
    [Google Scholar]
  12. Burt CA. Pneumatic rupture of intestinal canal. Arch Surg. 1931;22:875–902.
    [Google Scholar]
  13. Christensen P, Bazzocchi G, Coggrave M, Abel R, Hultling C, Krogh K, et al. A randomized, controlled trial of transanal irrigation versus conservative bowel management in spinal cord-injured patients. Gastroenterology. 2006;131:738–47.
    [Google Scholar]
  14. Christensen P, Krogh K, Buntzen S, Payandeh F, Laurberg S. Long-term outcome and safety of transanal irrigation for constipation and fecal incontinence. Dis Colon Rectum. 2009;52:286–92.
    [Google Scholar]
  15. Christensen P, Krogh K, Perrouin-Verbe B, Leder D, Bazzocchi G, Jakobsen BP, et al. Global audit on bowel perforations related to transanal irrigation. Tech Coloproctol. 2016;20:109–15.
    [Google Scholar]
  16. Farbin S, Davidson P, Shockley L. Perforation of the sigmoid colon by hydrostatic pressure of a public water fountain. J Emerg Med. 1996;14:703–6.
    [Google Scholar]
  17. Gill RS, Mangat H, Al-Adra DP, Evans M. Hydrostatic rectosigmoid perforation: a rare personal watercraft injury. J Pediatr Surg. 2011;46:402–4.
    [Google Scholar]
  18. Gedebou TM, Wong RA, Rappaport WD, Jaffe P, Kahsai D, Hunter GC. Clinical presentation and management of iatrogenic colon perforations. Am J Surg. 1996;172:454–7.
    [Google Scholar]
  19. GlobalSurg Collaborative. Mortality of emergency abdominal surgery in high-, middle- and low-income countries. Br J Surg. 2016;103:911–88.
    [Google Scholar]
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  • Article Type: Case Report
Keyword(s): hydrostatic , intestinal , perforation and pressure
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