title: Major rectal perforations caused by enema: is surgery mandatory?
abstract: BACKGROUND
  Current methods of large bowel preparation prior to colonoscopy, barium enema and surgery are extremely effective in cleaning the bowel of feces. We rationalize, therefore, that under these conditions rectal perforations secondary to barium and cleansing enema could be treated expectantly, namely either defer or completely avoid immediate surgery.
  
  
  METHODS
  Two female patients with major rectal perforations secondary to barium and cleansing enema who had thoroughly prepared large bowel were treated conservatively.
  
  
  RESULTS
  Both patients did well without surgery and were discharged without any long-term sequela.
  
  
  CONCLUSIONS
  Since a large number of iatrogenic perforations of the rectum occur in patients with well-prepared and clean bowel immediate surgery can be deferred or avoided all together without compromising them.
authors.affiliation: Department of Surgery B, Rabin Medical Center (Beilinson Campus), and Tel Aviv University School of Medicine, Tel Aviv, Israel.
authors.forename: O
authors.initials: O
authors.lastname: Madhala
authors.forename: F
authors.initials: F
authors.lastname: Greif
authors.forename: M
authors.initials: M
authors.lastname: Cohen
authors.forename: S
authors.initials: S
authors.lastname: Lelcuk
mesh_terms: D000368:Aged; D001466:Barium Sulfate; D004733:Enema / Q000009:adverse effects*; D005260:Female; D006801:Humans; D007416:Intestinal Perforation / Q000209:etiology* / Q000628:therapy*; D008875:Middle Aged; D012002:Rectal Diseases / Q000209:etiology*
chemical_list: D001466:Barium Sulfate