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Rectal Perforation following High-Pressure Distal Colostogram.
Giulia Brisighelli1, Liam Lorentz2, Tanyia Pillay2
1Department of Paediatric Surgery, Chris Hani Baragwanath Academic Hospital, University of the Witwatersrand, Johannesburg, South Africa.
European Journal of Pediatric Surgery Reports
|June 19, 2020
Summary
High-pressure distal colostograms for anorectal malformations can cause rare but life-threatening rectal perforations. Stopping contrast injection when the colon
Area of Science:
- Pediatric Surgery
- Radiology
- Gastroenterology
Background:
- High-pressure distal colostogram is crucial for surgical planning in anorectal malformations with colostomy.
- Rectal perforations are a rare but serious complication of this diagnostic procedure.
Observation:
- Two male patients with imperforate anus and colostomy experienced rectal perforations during high-pressure distal colostograms.
- One patient had an intraperitoneal perforation leading to death; the other had an extraperitoneal perforation with necrotizing fasciitis, but recovered.
Findings:
- Excessive contrast pressure during distal colostogram is the primary cause of rectal perforation.
- Intraperitoneal perforation can lead to hypovolemic/septic shock, requiring resuscitation and laparotomy.
- Extraperitoneal perforation necessitates close monitoring for complications like necrotizing fasciitis, potentially requiring debridement.
Implications:
- Identifying and avoiding excessive contrast pressure is key to preventing rectal perforations.
- Prompt recognition and management of both intraperitoneal and extraperitoneal perforations are critical for patient survival and recovery.
- This study highlights the importance of careful technique during high-pressure distal colostograms in pediatric patients.
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