title: Rectal perforation during defecography: extraluminal barium impaction removed by TEM (Transanal Endoscopic Microsurgery).
abstract: OBJECTIVE
  Defecography is the standard diagnostic technique for the diagnosis of functional disorders of the posterior pelvic compartment. However it has some limits as radiation exposure, low-contrast resolution, some degrees of embarrassment and discomfort for the patients. Furthermore it often fails to directly visualize the changes that affect the pararectal space. Here we present a never described case of rectal perforation after defecography with barium impaction removed by TEM (Transanal Endoscopic Microsurgery).
  
  
  METHODS
  We present a case of a 50 years old woman with extraluminal barium impaction due to perforation occurred during defecography. Both pelvic MR and endoanal ultrasound confirmed the presence of the extramural rectal mass below rectal mucosa. It was completely and safely removed using transanal endoscopic microsurgery (TEM).
  
  
  RESULTS
  The barium impaction has been radically removed using transanal endoscopic microsurgery. The post-operative period was uneventful and the patient was discharged 3 days after the operation. She is asymptomatic after 6 months from surgery.
  
  
  CONCLUSIONS
  Defecography is not completely safe and its use must be indicated only in selected cases. When a patient has complications during or after this investigation he must be referred to a specialistic centre where a tailored treatment can be performed. It is mandatory that the indication for defecography and other diagnostic functional investigations is given by a colorectal specialist KEY WORD: Barium Impaction, Defecography, Rectal Perforation, TEM (Transanal Endoscopic Microsurgery).
authors.forename: Gaetano
authors.initials: G
authors.lastname: Gallo
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Clerico
authors.forename: Roberta
authors.initials: R
authors.lastname: Tutino
authors.forename: Emilia
authors.initials: E
authors.lastname: De Luca
authors.forename: Alberto Realis
authors.initials: AR
authors.lastname: Luc
authors.forename: Mario
authors.initials: M
authors.lastname: Trompetto
mesh_terms: D001466:Barium Sulfate; D019841:Defecography / Q000009:adverse effects*; D005119:Extravasation of Diagnostic and Therapeutic Materials / Q000209:etiology / Q000601:surgery*; D005260:Female; D006801:Humans; D007416:Intestinal Perforation / Q000000981:diagnostic imaging / Q000209:etiology* / Q000601:surgery; D008279:Magnetic Resonance Imaging; D008866:Microsurgery / Q000379:methods*; D008875:Middle Aged; D057605:Natural Orifice Endoscopic Surgery / Q000379:methods*; D012002:Rectal Diseases / Q000209:etiology; D012007:Rectum / Q000293:injuries*; D014456:Ulcer / Q000209:etiology; D014463:Ultrasonography
chemical_list: D001466:Barium Sulfate