Enema-Induced Rectal Perforation Complicated by Rapidly Progressive Fournier Gangrene in a Frail Elderly Patient: A Clinical Case Report

Authors : Cagri Akalin, Seray Aydin, Nurullah Kadim, Abdullah Cirakoglu, Mumin Demir, Gokhan Zaim

Pages : 138-143

Doi:10.56941/odutip.1831424

View : 34 | Download : 127

Publication Date : 2025-12-31

Article Type : Other Papers

Abstract :The following case study is presented in order to illustrate a rare instance of enema-induced rectal perforation in a patient of advanced age who was also frail. The condition rapidly progressed to Fournier gangrene. The importance of early diagnosis, faecal diversion, and staged surgical debridement is emphasised. A 73-year-old male patient suffering from Alzheimer\\\'s disease and intellectual disability developed acute perineal pain following the administration of a cleansing enema. A comprehensive clinical examination was conducted, and laboratory tests were performed. Contrast-enhanced computed tomography was also conducted. The patient underwent an emergency laparotomy, which included the Hartmann procedure, followed by staged perineal–inguinal debridements. The patient\\\'s clinical progress was meticulously monitored throughout their hospitalisation. Imaging revealed extensive subcutaneous emphysema of the perineum, hemiscrotum, and inguinal canal with perirectal free air, indicating rectal perforation. Intraoperatively, a 1-cm full-thickness perforation was detected at the 12 o\\\'clock position of the rectum. A Hartmann procedure was performed, followed by three staged debridements due to advancing necrotising fasciitis. The wound was closed primarily on postoperative day 18, and the patient was discharged in stable condition. It is important to note that enema-induced rectal perforation has the potential to result in fulminant Fournier gangrene, a condition that is especially prevalent in elderly patients who are considered to be frail. Early CT evaluation, prompt faecal diversion, and serial debridement are essential for successful outcomes. It is imperative that clinicians maintain heightened awareness when managing vulnerable patients undergoing enema procedures.
Keywords : Rektal perforasyon, Lavman, Fournier gangreni, Nekrotizan fasiit, Hartmann prosedürü

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