Enema-induced perforation of the rectum in chronically constipated patients

INTRODUCTION: The use of retrograde irrigation enemas is common in the trea tment of chronic constipation, especially in the elderly. Perforation of th e rectum and sigmoid colon caused by cleansing enemas, used by chronically constipated patients, has not been previously described. METHODS: We review ed all patients with colorectal perforations caused by irrigation enemas ad mitted to our sen ice in the three-lear period between January 1995 and Dec ember 1997. RESULTS: Thirteen patients were treated by our surgical service because of perforations of the rectum and sigmoid colon related to a previ ous retrograde irrigation enema. Ten of these patients came from nursing ho mes, and the other three lived at home. The relevant information relating t he enema administration to the patient's condition was given in only two of the ten patients referred to the emergency room by the institution's nursi ng or medical staff. In the other eight the information was vague and somet imes misleading. The diagnosis of colorectal perforation tvas made by histo ry, plain abdominal x-rays, and CT scan with or without medglumine diatrizo ate enemas. Ten patients survived, regardless of age, previous diseases, or operative findings. In all of them, diagnosis was made within 36 hours fro m the perforation. The three deaths occurred in patients in whom the diagno sis was made late. CONCLUSIONS: Awareness of the possible injury from enema s administered to chronically constipated patients should be stressed. A hi gh degree of suspicion by the attending physician is extremely important, b ecause prompt diagnosis and early surgical treatment curies a relatively go od prognosis.