A perforated rectum involves a tear or hole in the wall of the rectum, the final section of the large intestine. This condition represents a serious medical emergency where the integrity of the bowel is compromised. Contents from the rectum can leak into the abdominal cavity, potentially leading to severe complications. Prompt medical attention is necessary to address this injury effectively.
Understanding Perforated Rectum
A perforated rectum can arise from various circumstances, often involving direct physical compromise to the rectal wall. Accidental trauma, such as foreign object insertion, can directly cause a tear.
Medical procedures sometimes lead to this injury. For instance, a colonoscopy carries a small risk of perforation. Rectal or pelvic surgeries also present a low risk of accidental damage to the rectal wall.
Inflammatory bowel diseases, including Crohn’s disease or ulcerative colitis, can weaken rectal tissue. Prolonged inflammation can thin the bowel wall, leading to perforation. Diverticulitis may also extend to the rectum and, in severe cases, lead to a perforation if an inflamed pouch ruptures. Severe constipation causing fecal impaction can tear the rectal lining.
Recognizing the Signs
Recognizing the signs of a perforated rectum often begins with severe abdominal pain, localized in the lower abdomen or pelvic region. This pain can be sudden and steadily worsen. Rectal pain may also be present.
The body’s response to internal leakage and potential infection includes systemic symptoms. Fever and chills are common indicators of an inflammatory or infectious process. Nausea and vomiting frequently accompany these symptoms.
Changes in bowel habits are a significant indicator. Individuals might experience an inability to pass stool or gas, known as obstipation. The presence of blood in the stool or rectal bleeding can also signal a perforation.
Diagnostic Methods
Diagnosing a perforated rectum begins with a thorough physical examination. Medical professionals assess for tenderness, rigidity, or distension in the abdomen. Bowel sounds can also provide clues about digestive tract activity.
Imaging tests confirm the diagnosis and pinpoint the perforation’s location. An abdominal X-ray may reveal free air under the diaphragm. A computed tomography (CT) scan can precisely identify air or fluid collections outside the rectal wall and show inflammation. Magnetic resonance imaging (MRI) may also provide detailed images to identify the tear’s exact site.
Laboratory tests provide additional information about the body’s response. Blood tests, such as a complete blood count (CBC), may show an elevated white blood cell count, indicating infection or inflammation. Other blood markers, like C-reactive protein (CRP), can also be elevated.
Treatment and Management
Addressing a perforated rectum requires immediate surgical intervention to repair the tear and manage contamination. The primary goal of surgery is to close the perforation and thoroughly clean the abdominal cavity, known as peritoneal lavage, to prevent or treat peritonitis. The specific surgical approach depends on the perforation’s size, location, and degree of contamination.
One common surgical technique is primary repair, where the surgeon stitches the hole in the rectal wall. This method is preferred when the perforation is small, clean, and detected early. In cases of significant tissue damage, extensive contamination, or patient instability, a colostomy may be created. This procedure diverts the end of the colon through an abdominal wall opening, allowing stool to exit the body into a bag and bypassing the injured rectum for healing.
A colostomy can be temporary, with a subsequent surgery performed later to reverse it and reconnect the bowel. Alongside surgical repair, supportive care includes broad-spectrum intravenous antibiotics to combat infections. Intravenous fluids maintain hydration and electrolyte balance, and pain medications alleviate discomfort.
Potential Complications
Untreated or delayed treatment of a perforated rectum can lead to severe complications. Peritonitis, a widespread infection and inflammation of the abdominal lining, results from fecal matter leaking into the abdominal cavity. This condition can rapidly progress and cause significant systemic illness.
Sepsis, a life-threatening response to infection, can develop if peritonitis is not controlled. This can lead to organ dysfunction. Severe sepsis can result in septic shock, characterized by dangerously low blood pressure and inadequate blood flow to organs.
Localized collections of pus, known as abscesses, can form within the abdominal cavity or around the rectum. These often require drainage. In severe cases of sepsis or prolonged infection, multi-organ failure can occur. Some patients may require a permanent colostomy, meaning living with a stoma and external bag for waste collection.