Rectum perforation during transanal irrigation: a case story

Study design: Case report. Objective: Report a case of rectum perforation during transanal irrigation (TAI). Setting: Clinic for Spinal Cord Injuries, and Departments of Gastroenterological Surgery and Radiology. Case report: A 54-year-old woman with spinal cord lesion for 35 years emptied for years her bowel using oral laxative. This became more difficult and took more than 2 h three times a week with reflex stimulation after a chlysma. She wanted to try TAI, and went through the procedure with a nurse one time. The next time she performed the TAI by herself without difficulty. Two hours later she started shivering with a temperature at 38.3 °C with normal blood pressure (BP). At rectal exploration, a spoonful fresh blood was found. After another 2h, she became septic and was transferred to a gastroenterological surgical department. An abdominal X-ray gave no suspicion of free air in the abdomen. Sigmoideoscopy showed 3-5 cm oral to the dentate line a 1 x 1 cm transmural circular lesion. A colon X-ray with water contrast showed a perforation of approximately 2 x 0.5cm. Conclusion: Even in experienced individuals who are proper trained, TAI can cause rectal perforation, which always have to be born in mind.