Sigmoid colon perforation following a self-administered cleansing enema: a case report

Unsupervised self-administered cleansing enemas pose a rare but catastrophic risk of colorectal perforation. We report a 71-year-old man presenting with acute peritonitis immediately after a self-enema for chronic constipation. Notably, he connected the enema hose directly to a household water tap, inadvertently introducing a large volume of water under high mains pressure. Radiography revealed pneumoperitoneum. Emergency laparotomy identified a 5-cm longitudinal blowout perforation on the mesenteric border of the sigmoid colon with fecal contamination. A Hartmann-type procedure (partial sigmoid resection with an end colostomy) was performed. Histopathology confirmed a structurally normal colonic wall devoid of underlying pathologies. The findings were consistent with massive hydrostatic pressure injury, likely exacerbated by distal fecal loading. The patient recovered uneventfully, with no complications at the 30-day follow-up. This case highlights the extreme danger of connecting enema devices directly to domestic water supplies and emphasizes prompt surgery for atypical barogenic perforations.