title: Perforations of the rectosigmoid colon induced by cleansing enema: CT findings in 14 patients.
abstract: BACKGROUND
  We report the computed tomographic (CT) features of colorectal perforations caused by cleansing enema.
  
  
  METHODS
  We reviewed the medical records and CT studies of all patients with colorectal perforations caused by a cleansing enema.
  
  
  RESULTS
  Fourteen patients (10 men, four women; average age = 80 years) were included in the study. The most common presenting symptoms were severe abdominal pain and fever. CT was performed within 48 h after the event in most patients. Extraluminal air in the perirectal fat was the most frequent finding on CT and was present in all patients. Additional findings were extraperitoneal ( n = 9), intraperitoneal ( n = 3) and /or subcutaneous ( n = 3) air, free fluid ( n = 9), extraluminal feces ( n = 8), and focal bowel wall thickening ( n = 4). No leak of contrast from the rectum was observed in any patient including the one patient in whom contrast was administered rectally. Ten patients were treated by surgery; five recovered and the other five died. The other four patients were treated conservatively and all four died.
  
  
  CONCLUSIONS
  The diagnosis of colorectal perforation can be made on CT. Because the diagnosis is not always suspected by the clinician, the radiologist may be the first to suggest it. Therefore, the radiologist should be familiar with the CT features of a potentially lethal, rectally induced perforation.
authors.affiliation: Department of Diagnostic Imaging, Sheba Medical Center affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Hashomer 52621, Israel.
authors.forename: G
authors.initials: G
authors.lastname: Gayer
authors.forename: R
authors.initials: R
authors.lastname: Zissin
authors.forename: S
authors.initials: S
authors.lastname: Apter
authors.forename: A
authors.initials: A
authors.lastname: Oscadchy
authors.forename: M
authors.initials: M
authors.lastname: Hertz
mesh_terms: D015746:Abdominal Pain / Q000209:etiology; D000368:Aged; D000369:Aged, 80 and over; D004733:Enema / Q000009:adverse effects*; D005260:Female; D006801:Humans; D007416:Intestinal Perforation / Q000000981:diagnostic imaging* / Q000209:etiology; D008297:Male; D008875:Middle Aged; D012002:Rectal Diseases / Q000000981:diagnostic imaging* / Q000209:etiology; D012810:Sigmoid Diseases / Q000000981:diagnostic imaging* / Q000209:etiology; D014057:Tomography, X-Ray Computed