title: Rectal perforation after procedure for prolapse and hemorrhoids: possible causes.
abstract: OBJECTIVE
  Our aim was to explore possible causes of rectal perforation occurring in patients who undergo the procedure for prolapse and hemorrhoids.
  
  
  METHODS
  We evaluated data from cases of rectal perforation that occurred after the procedure for prolapse and hemorrhoids in China in conjunction with case reports from the international medical literature.
  
  
  RESULTS
  We identified 7 patients from 5 hospitals in 2 provinces of China who had rectal perforation after the procedure despite having received prophylactic antibiotic treatment. Two patients had a disrupted staple line and 5 had perforations on the rectum wall above the intact staple line. Six patients presented with symptoms in the first 3 days after the procedure. Three patients had concomitant disease: 1 had concomitant constipation and internal rectal prolapse, 1 had concomitant constipation, and 1 had concomitant liver cirrhosis ascites that was not diagnosed preoperatively. Of the 15 cases of rectal perforation found in the literature, 3 patients had an intact staple line and 5 patients had a ruptured staple line.
  
  
  CONCLUSIONS
  The cone-shaped tip of the anvil, concomitant rectal prolapse and pelvic floor descent, and concomitant ascites are possible causes of rectal perforation after the procedure for prolapse and hemorrhoids.
authors.affiliation: Department of Colorectal Surgery of Changhai Hospital, Second Military Medical University, Shanghai, China.
authors.forename: Xian Hua
authors.initials: XH
authors.lastname: Gao
authors.forename: Han Tao
authors.initials: HT
authors.lastname: Wang
authors.forename: Ji Gui
authors.initials: JG
authors.lastname: Chen
authors.forename: Xiao Dong
authors.initials: XD
authors.lastname: Yang
authors.forename: Qun
authors.initials: Q
authors.lastname: Qian
authors.forename: Chuan Gang
authors.initials: CG
authors.lastname: Fu
mesh_terms: D000328:Adult; D000368:Aged; D015331:Cohort Studies; D005260:Female; D006484:Hemorrhoids / Q000209:etiology / Q000473:pathology / Q000601:surgery*; D006801:Humans; D007416:Intestinal Perforation / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D012005:Rectal Prolapse / Q000209:etiology / Q000473:pathology / Q000601:surgery*; D012189:Retrospective Studies; D012307:Risk Factors; D017792:Surgical Stapling; D016896:Treatment Outcome