Professional Documents
Culture Documents
Iatrogenic Rectal Injury
Iatrogenic Rectal Injury
Intraoperative Injury
• injury during other procedures
• especially during pelvic operations
• The key to managing is early recognition.
– The vast majority
• closed primarily
– If little contamination
– If the patient is otherwise stable.
• gynecologic procedures
– dilatation and curettage of the uterus
– Total abdominal hysterectomy and vaginal hystere
ctomy
– Intrauterine devices have been known to erode int
o the peritoneal cavity and subsequently into the c
olon
• Urologic surgery
– Percutaneous nephrostomy
– Perineal prostatectomy
– suprapubic prostatectomy
– Transurethral resection of the prostate
• Neurosurgical
– Inserting ventriculoperitoneal shunts
• Orthopedic operations
– internal fixation of a hip fracture
• Colorectal stents
– stent insertion attempts.
• Perforation occurred in 22 (4%)
• Delayed recognition
– result in significant peritonitis and life-threatening
sepsis.
• Treatment : fecal diversion
– patient may need repeated exploration for drainag
e of abscesses.
Injury from Barium Enema
• Cause
– direct penetration of the enema tip
– overinflation of the rectal balloon,
• Spillage of barium (especially above the peritoneal reflec
tion)
– profound peritonitis, sepsis, and a systemic inflammatory resp
onse.
• Manage
– recognized early
• closed primarily
• abdomen irrigated to remove stool and barium
• Manage
– recognized early
• closed primarily
• abdomen irrigated to remove stool and barium
• significant contamination
• delay in diagnosis with resulting peritonitis, or unsta
ble
– proximal diversion with or without resection is the safest
approach
• indication for and findings at the time of colonoscopy.
– If the patient has neoplasm and is stable
– Definitive resection is best