PMC7346698_01
(a) Axial view, (b) coronal view, and (c) sagittal view of the abdominopelvic CT findings show an abscess in the right rectal wall (2.3 cm x 4.7 cm x 2 cm in diameter) and a fistula (white arrow).
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Abdominal computed tomography (CT) revealed the presence of a right perirectal abscess lesion with wall thickening of the rectum and perirectal fat stranding and free air (Figure 1(a)-(c)).
The colonoscopic findings include (a) a fistula in the right side wall of the rectum, which was (b) completely closed using hemostatic clipping.
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Colonoscopy revealed a fistula in the right side of middle rectal wall (Figure 2(a)). The fistula was closed completely using multiple hemostatic clippings, and there was no event of procedure-related complications (Figure 2(b)).
The coronal CT image shows the remarkable disappearance of the abscess (black arrow).
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Five days later, a significant improvement in the patient's laboratory parameters was observed and CT revealed the disappearance of the abscess (Figure 3).
PMC7346698_02
(a) Axial view, (b) and (c) coronal views of the CT image show multiple intraperitoneal air with a large amount of free fluid and extraluminal feces in the abdomen and pelvic cavity, and the coronal CT scan (white arrow) shows extraluminal air and feces in the right perirectal fat.
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Under the suspicion of the presence of complication from the recent enema, abdominal non-contrast CT was performed with creatinine elevation, which revealed pneumoperitoneum and large amounts of extra-luminal fecal material with ascites in the peritoneal cavity (Figure 4(a)-(c)).
The operative findings included (a) and (b) the entire colon and most of the small intestine with necrotic changes and upper rectal perforation (white arrow), for which (c) total colonic segment and massive small bowel resections were performed.
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During emergency laparotomy, necrotic changes were observed in most of the bowel and perforation occurred in the lateral side of the upper rectum (Figure 5(a)-(c)).