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Rectum perforation during transanal irrigation: a case story
F Biering-Sørensen1, J Bing, P Berggreen
1Clinic for Spinal Cord Injuries, Rigshospitalet & University of Copenhagen, Copenhagen, Denmark. finbs@rh.dk
Spinal Cord
|August 6, 2008
Summary
Transanal irrigation (TAI) can lead to rectal perforation, even in trained individuals. This case highlights the serious risks associated with TAI, emphasizing the need for vigilance.
Area of Science:
- Gastroenterology
- Colorectal Surgery
- Patient Safety
Background:
- Transanal irrigation (TAI) is used for bowel management in individuals with neurological conditions.
- A 54-year-old woman with a long-standing spinal cord lesion utilized TAI for bowel emptying.
- Previous bowel management involved oral laxatives and manual stimulation, which became less effective.
Observation:
- The patient experienced rectal bleeding and signs of sepsis (fever, shivering) two hours after performing TAI independently.
- Rectal examination revealed fresh blood, and sigmoidoscopy identified a transmural lesion 3-5 cm above the dentate line.
- A subsequent colon X-ray with water contrast confirmed a rectal perforation measuring approximately 2 x 0.5 cm.
Findings:
- The case report details a rectal perforation occurring during self-administered transanal irrigation.
- Despite prior training, the patient sustained a significant injury, leading to sepsis.
- Diagnostic imaging, including sigmoidoscopy and contrast X-ray, confirmed the perforation.
Implications:
- This case underscores the potential for serious complications, such as rectal perforation, associated with transanal irrigation.
- Healthcare providers must maintain a high index of suspicion for TAI-related injuries, even in patients with prior training.
- Enhanced patient education and monitoring may be necessary to mitigate the risks of transanal irrigation.
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