title: Rectal colonic mural hematoma following enema for constipation while on therapeutic anticoagulation.
abstract: Causes of colonic and recto-sigmoid hematomas are multifactorial. Patients can present with a combination of dropping hemoglobin, bowel obstruction and perforation. Computed tomography imaging can provide clues to a diagnosis of intramural hematoma. We present a case of rectal hematoma and a review of current management literature. A 72-year-old male on therapeutic anticoagulation for a pulmonary embolism, was administered an enema resulting in severe abdominal pain unresponsive to blood transfusion. A sigmoid colectomy with end colostomy was performed. Although rare, colonic and recto-sigmoid hematomas should be considered as a possible diagnosis for adults with abdominal pain on anticoagulant therapy.
authors.affiliation: Department of Surgery, Children's Mercy Hospital, Kansas City, MO 64108, USA rrentea@cmh.edu.
authors.forename: Rebecca M
authors.initials: RM
authors.lastname: Rentea
authors.affiliation: Department of Surgery, Medical College of Wisconsin, Milwaukee, WI, USA.
authors.forename: Charles H
authors.initials: CH
authors.lastname: Fehring