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Chirurgia 2005 October;18(5):349-52

language: Italian

Subcutaneous emphysema of the thorax and rectal perforation

Coli P.


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We have observed a 68 years old patient with subcutaneus emphisema and fever. It has been a extraperitoneal rectal perforation following an enema. Diagnosis is based on anamnesis, on objective examination and on diagnostic examination as rx abdomen and a idrosolubile clisma. Rectal perforations, although rare, are in costant increase.This is due to the use more frequent of diagnostic and theraputic methodic as endoscopic and rx. Another important cause is produced by enema. This happened in elderly patients wich presented chronic constipation.as our case. Rectum perforation can be intra o extraperitoneal. Symptomatology will be more manifest if intraperitoneal rectum is interessed sintomato with peritoneal sign. Extraperitoneal rectal perforations is associated to a less definite symptomatology. Symptoms as thoracic and neck subcutaneous emphysema o change of voice can be presented. Sometimes a progressive aggravation of patient clinical condition can be present so much to appear a septic shock. The treatment of rectum perforations is medical and surgical. Medical approach is found by use of a large spectrum antibiotic therapy and by support of vital functions for avoid or treat a septic shock. Surgical treatment will be depend on entity of lesion, if sphincter apparatus is involved or no, on clinical conditions of patient. The lesion must be see and expose. The treatments are diversify by suture of the breach to the Hartmann procedure o abdominal peritoneal amputation in the more severe cases.The associate treatment medical ad surgical has permitted (allowed) to reduced the mortality of rectum trauma by 90% of American Civil war to the present 5%.

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