PMC7224970_01
High-pressure distal colostogram lateral views (case 1). (
a
) Opacification of distal colon with convexity of distal rectal pouch. No rectourinary fistula is demonstrated. (
b
) Rectal pouch perforation with extraperitoneal contrast extravasation. (
c
) Progression of the extraperitoneal contrast extravasation. (
d
) progression of the contrast extravasation, extending into the peritoneum.
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The contrast study was complicated by a rectal perforation with initial extraperitoneal contrast leak and progressive contrast spillage into the peritoneal space ( Figs. 1 and 2 ).
Case 1. High-pressure distal colostogram anteroposterior view showing the massive intraperitoneal extravasation of Urografin.
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The contrast study was complicated by a rectal perforation with initial extraperitoneal contrast leak and progressive contrast spillage into the peritoneal space ( Figs. 1 and 2 ).
PMC7224970_02
PMC7224970_03
High-pressure distal colostogram (case 2). (
a
) Lateral view: opacification of the distal colon with convexity of distal rectal pouch. No rectourinary fistula is demonstrated. (
b
) Rectal pouch perforation with contrast extravasation into the perineum. (
c
) Lateral view: progressive perineal contrast extravasation extending into the scrotum. (
d
) Anteroposterior view: progressive perineal contrast extravasation extending into the scrotum.
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The contrast study was complicated by distal rectal pouch perforation and extravasation of contrast into the perineum and scrotum ( Fig. 3 ).
Case 2. Features of the perineum and scrotum immediately after the perforation occurred.
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Necrotizing fasciitis was macroscopically confirmed, and an extensive scrotal and perineal debridement was performed ( Fig. 4 ).
Case 2. Features of the perineum and scrotum 24 hours after the perforation occurred with macroscopic necrotizing fasciitis.
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Two days later, a second debridement was performed ( Fig. 5 ).
Case 2. Left: features of the perineum and scrotum 72 hours after the extraperitoneal rectal perforation (after the second debridement). Right: perineum and scrotum 6 weeks after the perforation.
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Six weeks following the rectal perforation, the child underwent an examination under anesthesia, which indicated scrotal wound healing and a rectoperineal fistula anterior to the muscle complex that could fit a 4-mm Hegar dilator ( Fig. 6 ).