Perforated Rectal Diverticulum following Prostate Biopsy Resulting in Peri-Rectal Abscess and Sepsis

Abstract

Background: Transrectal ultrasound guided prostate biopsy (TRUS-PB) is a common investigation for assessment of prostatic carcinoma. Loco-regional complications of TRUS-PB are uncommon and usually relate to infective processes from bacteria present in the rectum. We present a novel case of an abscess from a rectal diverticular perforation secondary to TRUS-PB to highlight this complication as a potential concern for this diagnostic modality. Methods: We present a 55-year-old male who underwent TRUS-PB for investigation of elevated prostate-specific antigen (PSA) (PSA 3.5ug/l). Three weeks following this procedure, at the hospital, the patient presented with septic shock requiring inotropic support. Computed tomography (CT) identified a contained rectovesical abscess anterior to the upper rectum. The patient required operative intervention as he failed to improve on conservative management. Histopathological assessment confirmed recent perforation through the anterior rectum via a rectal diverticulum. Results: Post-operatively, the patient recovered rapidly and was discharged day nine. The patient underwent a laparoscopic-assisted reversal of Hartmann's stoma approximately 8 mo after his initial operation.

Diagnostic Accuracy of Robot-Guided, Software Based Transperineal MRI/TRUS Fusion Biopsy of the Prostate in a High Risk Population of Previously Biopsy Negative Men

“…The patient received immediate endorectal clipping of the lesion and fully recovered without further complications. Few case reports exist on this complications [23]. It might be underestimated complications because late onset of the symptoms might occur and most of the complications regarding transrectal ultrasound and/or biopsy of the prostate are reported within 24 h [6].…”

Comparison of the complications of traditional 12 cores transrectal prostate biopsy with image fusion guided transperineal prostate biopsy

“…Though the minor complications rate of hematuria, rectal bleeding, hematospermia, vasovagal episodes, infection was reported to be similar in these two techniques [6], transrectal prostate biopsy had more major complicationse.g. sepsis, bleeding or other complications requiring admission compared with the transperineal biopsy [7, 8]. More importantly, an increasing risk of septic shock was reported in the transrectal biopsy, which might be life-threatening [9, 10].…”

Pulsion diverticula of the rectum: Radiological diagnosis and clinical implications

“…19 Accidental perforation of rectal diverticula during colonoscopy or ultrasound guided prostate biopsy has been reported. 20,21 Some patients with symptomatic rectal diverticulum had required resection of the lesion through endorectal diverticulectomy. 14,22 In the majority of reported cases, however, the treatment had been directed towards the coexisting anorectal lesions or defecation disorders.…”