Rectal perforations and fistulae secondary to a glycerin enema:Closure by over-the-scope-clip

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.

Metal stent combined with ileus drainage tube for the treatment of delayed rectal perforation: A case report

BACKGROUND Acute iatrogenic colorectal perforation(AICP)is a serious adverse event,and immediate AICP usually requires early endoscopic closure.Immediate surgical repair is required if the perforation is large,the endoscopic closure fails,or the patient's clinical condition deteriorates.In cases of delayed AICP(>4 h),surgical repair or enterostomy is usually performed,but delayed rectal perforation is rare.CASE SUMMARY A 53-year-old male patient underwent endoscopic submucosal dissection(ESD)at a local hospital for the treatment of a laterally spreading tumor of the rectum,and the wound was closed by an endoscopist using a purse-string suture.Unfortunately,the patient then presented with delayed rectal perforation(6 h after ESD).The surgeons at the local hospital attempted to treat the perforation and wound surface using transrectal endoscopic microsurgery(TEM);however,the perforation worsened and became enlarged,multiple injuries to the mucosa around the perforation and partial tearing of the rectal mucosa occurred,and the internal anal sphincter was damaged.As a result,the perforation became more complicated.Due to the increased bleeding,surgical treatment with suturing could not be performed using TEM.Therefore,the patient was sent to our medical center for follow-up treatment.After a multidisciplinary discussion,we believed that the patient should undergo an enterostomy.However,the patient strongly refused this treatment plan.Because the position of the rectal perforation was relatively low and the intestine had been adequately prepared,we attempted to treat the complicated delayed rectal perforation using a self-expanding covered mental stent(SECMS)in combination with a transanal ileus drainage tube(TIDT).CONCLUSION For patients with complicated delayed perforation in the lower rectum and adequate intestinal preparation,a SECMS combined with a TIDT can be used and may result in very good outcomes.