Asian Journal of Case Reports in Surgery

Background: Rectal perforation following direct transanal penetration by a household hand shower spray gun is an uncommon injury that may result in intraperitoneal contamination and requires timely assessment. This report describes the presentation, operative findings and early postoperative course of a patient with rectosigmoid perforation after accidental insertion of the spray-gun nozzle.

Case Presentation: A previously healthy 28-year-old man presented approximately 48 hours after the injury with rectal bleeding, progressive lower abdominal pain and abdominal distension. Examination demonstrated blood staining around the anal verge, blood clots on digital rectal examination and abdominal tenderness with guarding. Proctoscopy showed blood clots but did not reveal the perforation. An erect abdominal radiograph demonstrated pneumoperitoneum. Contrast-enhanced computed tomography showed extravasation of contrast from the upper rectum, consistent with intraperitoneal perforation. Emergency exploratory laparotomy identified a 4 × 3 cm defect in the anterior rectosigmoid wall, with extensive faecal contamination and foul-smelling peritoneal fluid. The perforation margins were debrided, and the defect was repaired in two layers with interrupted 3-0 polydioxanone sutures. The peritoneal cavity was lavaged, and a diverting loop ileostomy was fashioned. Postoperative recovery was uneventful, and the patient was discharged with plans for follow-up and subsequent ileostomy closure after confirmation of healing.

Conclusion: This case illustrates the need to consider rectal perforation after transanal trauma, even when proctoscopy does not identify a defect. Imaging and surgical exploration informed management in a patient with delayed presentation and generalised peritonitis.