Iatrogenic colorectal perforation induced by anorectal manometry: report of two cases after restorative proctectomy for distal rectal cancer.
There are no reports regarding perforation of the colorectum induced by anorectal manometry. We report two cases of colorectal perforation that occurred during manometry in the patients undergoing restorative proctectomy for distal rectal cancer. In the first patient, computed tomography showed an extraperitoneal perforation in the pelvic cavity and a rupture of the rectal wall. A localized perforation into the retroperitoneum was managed conservatively. In the second patient, a 3 cm linear colon rupture was detected above the anastomotic site. A primary closure of the perforated colon and proximal ileostomy were conducted, but the patient died 2 wk later. We hypothesize that the perforation induced by anorectal manometry may be associated with the relative weakening of the proximal bowel wall due to anastomosis, decreased compliance, and abnormal rectal sensation. We suggest that measurement of the maximum tolerable volume should not be routinely performed after restorative proctectomy for distal rectal cancer.
Park
Jun-Seok
JS
Department of Surgery, Seoul National University Bundang Hospital, 300 Gumi-dong Bundang-gu, Seongnam-si, Gyeonggi-do 463-707, Korea.
Kang
Sung-Bum
SB
Kim
Duck-Woo
DW
Kim
Na-Young
NY
Lee
Kyoung-Ho
KH
Kim
Young-Hoon
YH
D000368:Aged; D003108:Colonic Diseases / Q000209:etiology*; D003938:Diagnostic Techniques, Digestive System / Q000009:adverse effects*; D006801:Humans; D007049:Iatrogenic Disease; D008297:Male; D008365:Manometry / Q000009:adverse effects; D012002:Rectal Diseases / Q000209:etiology*; D012004:Rectal Neoplasms / Q000601:surgery