Open AccessRectal perforations and fistulae secondary to a glycerin enema: Closure by over-the-scope-clip
Author(s) -
Hideki Mori,
Hideki Kobara,
Shintaro Fujihara,
Noriko Nishiyama,
Mitsuyoshi Kobayashi,
Tsutomu Masaki,
Kunihiko Izuishi,
Yasuyuki Suzuki
Publication year - 2012
Publication title -
world journal of gastroenterology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.427
H-Index - 155
eISSN - 2219-2840
pISSN - 1007-9327
DOI - 10.3748/wjg.v18.i24.3177
Subject(s) - medicine , fistula , surgery , perforation , abscess , rectum , enema , peritonitis , saline , anesthesia , materials science , punching , metallurgy
Rectal perforations due to glycerin enemas (GE) typically occur when the patient is in a seated or lordotic standing position. Once the perforation occurs and peritonitis results, death is usually inevitable. We describe two cases of rectal perforation and fistula caused by a GE. An 88-year-old woman presented with a large rectal perforation and a fistula just after receiving a GE. Her case was further complicated by an abscess in the right rectal wall. The second patient was a 78-year-old woman who suffered from a rectovesical fistula after a GE. In both cases, we performed direct endoscopic abscess lavage with a saline solution and closed the fistula using an over-the-scope-clip (OTSC) procedure. These procedures resulted in dramatic improvement in both patients. Direct endoscopic lavage and OTSC closure are very useful for pararectal abscess lavage and fistula closure, respectively, in elderly patients who are in poor general condition. Our two cases are the first reports of the successful endoscopic closure of fistulae using double OTSCs after endoscopic lavage of the debris and an abscess of the rectum secondary to a GE.