P0180 - Rectal Perforation; A Rare Complication From Anorectal Manometry: A Case Report and Literature Review

Christopher Picking, MD¹, Avanija Buddam, MBBS², Subhash Chandra, MBBS^2
1Creighton University Medical Center, Omaha, NE; ²Creighton University, Omaha, NE

Introduction: Anorectal manometry (ARM) with maximum tolerated volume (MTV) is a commonly utilized modality for assessing anal sphincter function as well as rectal pressure, sensation, and anorectal dyssynergia. Rectal perforation is a rare complication, with only 8 cases reported in the literature. Here we report a case of rectal perforation from anorectal manometry in a patient with a history of multiple pelvic surgeries.

Case Description/Methods: A 79-year-old Caucasian female experienced rectal perforation during anorectal manometry, performed in the work-up of fecal incontinence. Initial work-up included colonoscopy showing scattered sigmoid diverticula, as well as hemorrhoids on the perianal exam. Surgical history was significant for a total hysterectomy with bilateral oophorectomy, multiple bladder sling surgeries, and 3 vaginal deliveries without episiotomy. Two months after colonoscopy, ARM with MTV was performed. The sensation was noted at 40 ml, MTV at 80 ml, and the patient was not able to expel the rectal balloon in 2 minutes. Bleeding and abdominal pain were noted after the procedure which progressively worsened. A computed tomography scan showed extraperitoneal perforation of the rectum and so she was immediately taken to the operating room. Posterior distal rectal full-thickness perforation, 2 cm above the anal verge, 4x3 cm in size was noted on flex sigmoidoscopy, and significant intra-abdominal adhesions were noted on laparoscopy. Laparoscopic diverting loop ileostomy with lysis of adhesions was performed, and the patient was discharged 7 days later.

Discussion: After a review of available literature, underlying risk factors and warning signs for perforation are present throughout. In our case, the perforation was likely the result of tight angulation of the distal rectum, likely from multiple bladder incontinence surgeries. As rectal perforation is an exceedingly rare complication of ARM, risk factors and warning signs for perforation may not be recognized by those performing the procedure. The provided table identifies high-risk patients, allowing for increased caution when performing ARM. It also provides common warning signs that perforation has occurred, to not delay intervention.



Disclosures:


Christopher Picking, MD¹, Avanija Buddam, MBBS², Subhash Chandra, MBBS². P0180 - Rectal Perforation; A Rare Complication From Anorectal Manometry: A Case Report and Literature Review, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.