Sigmoid colon perforation caused by three living loaches inserted into anus: a case report

Abstract BACKGROUND Colorectal perforation are common surgical emergencies. Yet perforation caused by living animals has not been reported with no record found on Medline. CASE PRESENTATION A 47-year-old male arrived at our surgical emergency room for "severe abdominal pain with itchy rash for 5 hours", who explained that "three big living loaches" had been squeezed into the anus 1 hour before the onset of symptoms. Thorough physical and auxiliary examinations suggested lower gastrointestinal perforation. After prompt anti-shock, anti-allergy, analgesia and gastrointestinal decompression, we performed exploratory laparotomy, sigmoid colon repair and double-lacuna ileostomy. The patient underwent uneventful postoperative recovery and was discharged on the 10th day after surgery. CONCLUSIONS CT examination is critical for diagnosing colorectal perforation caused by living animals (3 loaches as reported in our case). Specifically, due attention should be given to the serious allergic reaction induced by exogenous organisms entering the abdominal cavity. Surgery should be performed as soon as possible to fundamentally address the allergic shock. As to colorectal perforation caused by multiple living organisms, considering the restricted condition for thorough exploration during emergency surgery (particularly the exploration of the posterior wall of the colon), colostomy should be selected with caution.