Perforated rectum: intraperitoneal zucchini

Case contributed by Assoc Prof Frank Gaillard

Presentation

Generalized abdominal pain.

Patient Data

Age: 50 years
Gender: Male

Abdominal x-ray

x_ray

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

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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