Perforations of the distal large intestine produced by intraluminal traumas

Abstract Thirteen cases of perforation of the distal large intestine produced by intraluminal injuries are presented. One of these perforations was self-produced by insertion of a broom handle into the anorectal canal; one was the result of a cleansing enema given by the patient's wife; and the remainder occurred at the time of diagnostic or therapeutic procedures. Although it is difficult to determine the true incidence of such injuries, several surveys indicate that such accidents may be more common than we realize. In addition to the etiological factors involved in the thirteen cases presented, a review of other possible etiological factors is given. The clinical manifestations are reviewed. Intraperitoneal perforations usually are more serious than extraperitoneal perforations. Both types of perforations should be diagnosed and supportive measures instituted immediately. With an intraperitoneal perforation emergency laparotomy is mandatory unless the patient is moribund. If circumstances are quite favorable, primary closure may be the only operative intervention. If the findings are not favorable, some type of colostomy should be performed. In the event of an extraperitoneal perforation involving the lower part of the rectum, non-operative therapy may suffice. However, a proximal colostomy may be necessary, and drainage of the perirectal and presacral areas may be indicated. The mortality rate is not low. In several large series, the rate varied from 12 to 68 per cent with the majority of the figures being closer to the higher rate. The rate was 31 per cent among the thirteen patients discussed herein.