Case Report
Copyright ©2007 Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Dec 7, 2007; 13(45): 6112-6114
Published online Dec 7, 2007. doi: 10.3748/wjg.v13.i45.6112
Iatrogenic colorectal perforation induced by anorectal manometry: Report of two cases after restorative proctectomy for distal rectal cancer
Jun-Seok Park, Sung-Bum Kang, Duck-Woo Kim, Na-Young Kim, Kyoung-Ho Lee, Young-Hoon Kim
Jun-Seok Park, Department of Surgery, Chung-Ang University Hospital, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do 463-707, Korea
Sung-Bum Kang, Duck-Woo Kim, Department of Surgery, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do 463-707, Korea
Na-Young Kim, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do 463-707, Korea
Kyoung-Ho Lee, Young-Hoon Kim, Department of Diagnostic Radiology, Seoul National University Bundang Hospital
Author contributions: All authors contributed equally to the work.
Correspondence to: Sung-Bum Kang, MD, Professor, Department of Surgery, Seoul National University Bundang Hospital, 300 Gumi-dong Bundang-gu, Seongnam-si, Gyeonggi-do 463-707, Korea. kangsb@snubh.org
Telephone: +82-31-7877093 Fax: +82-31-7874055
Received: August 19, 2007
Revised: September 17, 2007
Accepted: October 25, 2007
Published online: December 7, 2007
Abstract

There are no reports regarding perforation of the colorectum induced by anorectal manometry. We report two cases of colorectal perforation that occurred during manometry in the patients undergoing restorative proctectomy for distal rectal cancer. In the first patient, computed tomography showed an extraperitoneal perforation in the pelvic cavity and a rupture of the rectal wall. A localized perforation into the retroperitoneum was managed conservatively. In the second patient, a 3 cm linear colon rupture was detected above the anastomotic site. A primary closure of the perforated colon and proximal ileostomy were conducted, but the patient died 2 wk later. We hypothesize that the perforation induced by anorectal manometry may be associated with the relative weakening of the proximal bowel wall due to anastomosis, decreased compliance, and abnormal rectal sensation. We suggest that measurement of the maximum tolerable volume should not be routinely performed after restorative proctectomy for distal rectal cancer.

Keywords: Iatrogenic perforation, Anorectal manometry, Rectal cancer, Low anterior resection