Perforated rectum: intraperitoneal zucchini

Case contributed by Frank Gaillard
Diagnosis certain

Presentation

Generalized abdominal pain.

Patient Data

Age: 50 years
Gender: Male

Abdominal x-ray

x-ray
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Info

Bowel gas pattern is non-specific with no convincing free intrabdominal gas. Apparent density overlying the expected location of the rectum is difficult to interpret. 

CT abdomen

ct
Scout
This study is a stack
C+ portal
venous phase
This study is a stack
C+ portal
venous phase
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Info

19cm long oblong mostly air density object is seen within the peritoneal cavity (right epigastrium / periumbilical). The tip of it lies adjacent to the gallbladder. A discontinuity in the mid rectum, 9cm from the anal verge is noted where there is a 4 cm fluid/gas collection. Multiple locules of intraperitoneal free gas is also detected.

Case Discussion

CT is a useful modality to assess complications of rectal foreign bodies. It is important not to minimize or dismiss this clinical presentation As life-threatening complications occasionally, such as perforation. Untreated this would most likely lead to peritonitis. 

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