Unusual rectal perforation--an individualised approach to management

The management of rectal perforations is controversial. Surgical repair or resection and anastomosis is usually undertaken with faecal diversion in the management of traumatic perforations. Primary repair without colostomy is less commonly employed. Five cases of rectal perforation seen in the Department of Colorectal Surgery, three from penetrating foreign objects and two from barium enema examination, are presented. The principles of management of patients with rectal perforations include faecal diversion, primary repair of rectal perforation and sphincter muscles, presacral drainage, parenteral antibiotics and distal bowel irrigation. This approach was used in the management of these five cases and the results were very satisfying.