Colonic perforation with fecal peritonitis following fleet enema for chronic constipation
Diagnosis almost certain
Presentation
Acute abdomen following fleet enema for chronic constipation.
Patient Data
Age: 85 years
Gender: Male
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The CT scan demonstrates:
- distended colon filled with feces mainly in the rectum with no signs of diverticular disease or obstruction
- large retroperitoneal collection of feces and free gas posterior to the cecum and ascending colon, measuring 23 x 10 x 6 cm, extending inferiorly to the right iliac fossa and inguinal region, and superiorly around the right hepatic lobe.
- focal perforations at least at two levels of the posterior wall of the ascending colon, well-visualized on axial thin cuts
- fat stranding in the pelvic region with thickening of the peritoneal reflections
- small bilateral simple renal cysts
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- yellow arrows: retrocolonic collection of feces and gas
- red arrows: site of colonic perforation
Case Discussion
CT features of a colonic perforation of the posterior wall of the ascending colon with fecal peritonitis following fleet enema in a patient with chronic constipation (confirmed at surgery).
Additional contributor: A. Ramdani, MD
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