Laparoscopic Management of Rectal  Perforation Secondary to Self Induced  Foreign Body � A Rare case Report

Aditya Yelikar; Tejinder Singh Chhabda; Pravin Suryawanshi

Volume : II, Issue : I, January - 2013

Laparoscopic Management of Rectal Perforation Secondary to Self Induced Foreign Body � A Rare case Report

Aditya Yelikar, Tejinder Singh Chhabda, Pravin Suryawanshi

Abstract :

Laparoscopically managed rectal perforation secondary to self induced foreign body is a very rare case. Most common causes of rectal perforation are trauma and rectal impalement 1 . males are commonly affected 2,3. late presentations in rectal perforation can prove fatal . Our case was a 23 years old male well educated who presented with severe abdominal pain ,vomiting,1 episode bleeding per rectally and acute urinary retention (cathetrised immediately for 1 litre of urine). He gave no other history. On examination he had diffuse pain in the abdomen ,no guarding/ rigidity with fresh blood on DRE. USG suggested features of subacute intestinal obstruction and Xray abdomen standing showed no abnormality . He was admitted in the surgical ward. Ryles tube was inserted.I.V. fluids and antibiotics were started .after 8 hours of admission his abdominal pain increased despite appropriate analgesic .he developed guarding all over the abdomen,tachypnea and tachycardia. His repeat xray abdomen standing showed small amount of air under right dome of diaphragm. He was taken up for laparoscopic surgery . Intraoperatively there was evidence of two intact green leves in the peritoneum with a perforation over the anterior middle one third of the rectum. Leaves were extracted . Perforation was closed primarily . thorough peritoneal wash was given . Sigmoid loop colostomy was done. Postoperative period was uneventfull. Later on in post operative period patient gave a history of per rectal insertion of a pointed wooden stick with leaves at its tip on same morning of presentation. Colostomy was closed after 6 weeks with no complications post operatively. Rectal perforation should be considered as one of the differential diagnosis in cases of perforative peritonitis in young patients with no other obvious etiological factor . self induced foreign body can be a cause of rectal perforation in young patients . immediate surgical intervention is the treatment of choice and have good prognosis in cases of rectal perforation which can be managed successfully by laparoscopic method . such patient should also be referred to the psychiatrist in the post operative period for further psychological treatment .