Gastrointestinal: Asymptomatic rectal perforation and massive pneumoretroperitoneum in patient with ulcerative colitis treated with mesalamine enemas

摘要

A 76-year-old woman with a 4-year history of ulcerative proctitis presented with increased stool frequency of over 10 episodes of bloody diarrhea per day and lower abdominal pain. Physical examination revealed tenderness over the left lower abdomen. She was started on intravenous hydrocortisone. Sigmoidoscopy revealed diffuse hyperemic inflammation of the sigmoid colon and rectum (Figure la). Mesalamine enema was prescribed. A few days later, her diarrhea and rectal bleeding unproved slightly, but lower abdominal discomfort continued. Two days later, a prearranged abdominal computed tomography (CT) scan was performed and it showed massive amount of air in the pelvic and presacral space and along the lateral border of the psoas muscle (Figure lb). An urgent sigmoidoscopy revealed a 10 mm-sized deep laceration above the dentate line (Figure 2a). Surgical suturing of the laceration was performed and intravenous antibiotics were prescribed. The patient unproved without development of sepsis, generalized peritonitis, or aggravation of her colitis. She was discharged home after a 10-day hospitalization. Two weeks later, a follow-up CT scan demonstrated complete disappearance of retroperitoneal air (Figure 2b).