Anorectal manometry after rectal surgery: a case report with rectal bleeding and perforation

BACKGROUND: Anorectal manometry (ARM) is primarily used to assess anorectal sensorimotor function. ARM provides comprehensive information about the anal sphincter and rectal sensation in patients with constipation or fecal incontinence. Generally, ARM can be applied to both adults and children. This study is the first to report a case of post-rectal resection ARM with constipation complicating rectal bleeding and perforation in a patient with no history of rectal cancer, aiming to provide guidelines for the treatment of patients who undergo ARM after rectal surgery. CASE DESCRIPTION: A 58-year-old female patient with previous history of “hypertension and cerebral infarction” underwent “proctocolectomy” for “rectal prolapse” 11+ months ago and recovered well after the operation, but developed constipation. The patient was admitted to our hospital for anorectal manometry (ARM) for “constipation for 11+ months”. 2+ hours after the examination, the patient developed blood in the stool and was hospitalized in the Department of Anorectal Surgery of our hospital. The anorectal manometry was performed 2+ hours after the patient developed blood in the stool. The patient was discharged after 30 days of hospitalization without any complications. During treatment, the patient suffered from rectal rupture and perforation. Following timely and aggressive surgery, the patient recovered and was discharged without any complications. CONCLUSIONS: ARM with balloon, as a method for detecting anorectal function, should only be performed cautiously after rectal surgery, especially among patients with comorbidities. If patients suffer from anorectal bleeding and perforation during ARM, prompt and aggressive surgical intervention is necessary. At present, there is little literature on ARM teaching courses. To improve the operation level of ARM and reduce the incidence of complications, we should extend understandings of ARM, develop a systematic management plan, and continuously summarize ARM-related experiences.