Colorectal Perforation After Anorectal Manometry for Low Anterior Resection Syndrome

Abstract

We experienced 3 cases of manometry-induced colon perforation. A 75-year-old man (case 1) underwent anorectal manometry (ARM) 3 years after radiotherapy for prostate cancer and a laparoscopic intersphincteric resection for rectal cancer. A 70-year-old man (case 2) underwent ARM 3 months after conventional neoadjuvant chemoradiotherapy and a laparoscopic low anterior resection for rectal cancer. A 78-year-old man (case 3) underwent ARM 2 months after a laparoscopic intersphincteric resection for rectal cancer. In all cases, a colon perforation with fecal peritonitis occurred. All were treated successfully using prompt and active operations and were discharged without any complications. ARM with a balloon, as a measure of rectal compliance, should be performed 2 months or longer after surgery. If a perforation occurs, prompt and active surgical intervention is necessary due to the high possibility of extensive fecal peritonitis.

Variation in rectoanal inhibitory reflex after laparoscopic intersphincteric resection for ultralow rectal cancer

“…Indeed, our manometric data showed that the decreased percentage of MRP was significantly higher in the RAIR‐absent group compared with the RAIR‐present group (data not shown). More importantly, in order to avoid neorectal perforation, Lee et al have suggested that the manometric examination should be performed 2 months or longer after sphincter‐preserving surgery [30].…”

Broken beer bottle as a cause of sigmoid perforation: A summary of causes and predictors in the management of traumatic and non-traumatic colorectal perforation

“…However, the presence of profuse bleeding, advanced age, presence of comorbidities and sepsis are predictors of poor prognosis in these cases [7] , [9] , [14] , [15] , [16] . In general, perforation secondary to non-traumatic causes is more frequent, being predominantly due to colorectal cancer, ischemia, diverticulitis, inflammatory bowel disease, inadequate use of enema, iatrogenic endoscopy or anorectal manometry or fecal impaction [6] , [7] , [9] , [10] , [11] , [12] , [13] , [14] . Favorable prognostic factors for a satisfactory outcome in both traumatic and non-traumatic causes are early initiation of surgery and care in a specialized surgical center [6] , [12] .…”

“…Favorable prognostic factors for a satisfactory outcome in both traumatic and non-traumatic causes are early initiation of surgery and care in a specialized surgical center [6] , [12] . The unfavorable prognostic factors are advanced age, requirement of mechanical ventilation, prolonged stay in hospital and intensive care unit, APACHE II (Acute Physiology and Chronic Health Evaluation II) score between 8 and 30, SOFA (Sequential Organ Failure Assessment) score between 0 and 12, DIC (Disseminated Intravascular Coagulation) score between 0 and 8, POSSUM (Physiological and Operative Severity Score for the Enumeration of Mortality and Morbidity) score between 34 and 74, CT (Computerized Tomography) dirty mass volume in cm 3 (234 ± 211), presence of profuse bleeding, use of conservative treatment, performance of primary anastomosis without a diverting stoma, ASA Grade 3, 4 or 5, chronic steroid use, serum creatinine level > 3.0 mg/dL, disseminated cancer, white blood cell count <3500/mL, low preoperative systolic blood pressure and Hinchey classification IV [6] , [7] , [8] , [9] , [10] , [11] , [12] , [13] , [14] , [15] , [16] , [17] . Dirty mass is a little-known concept that represents the finding of focal collection of extraluminal fecal matter [19] .…”

“…The presence of unfavorable factors prolongs hospital stay, the risk of reoperation, perianal infection, peritonitis, sepsis and wound infection, generating mortality rates of up to 38% [6] , [7] , [8] , [9] , [10] , [11] , [12] , [13] , [14] , [15] , [16] , [17] . Considering the large number of cases and the heterogeneity of outcomes, it is clear that there is still much to be defined in the management of colorectal perforation.…”

“…We excluded those articles that did not present data on causes, predictors and outcomes of colorectal perforation, as well as those that did not have full text available. After the application of these criteria, 12 studies were finally included [6] , [7] , [8] , [9] , [10] , [11] , [12] , [13] , [14] , [15] , [16] , [17] . This case report followed the SCARE guidelines for its realization [18] .…”