82 year old woman with a history of hypertension under treatment and osteoarthritis underwent, during the diagnostic study of a picture of hematochezia, a scheduled opaque enema. During the study, the patient suffered intense abdominal and perineal pain accompanied by vegetative symptoms and nausea, so she was taken to the surgery observation room. On arrival, she was hemodynamically stable and did not feel ill. An examination showed she suffered pain in the left lower quadrant without peritonitis and a digital rectal exam was painful to finger tip pressure crackling mucosa around the entire circumference accessible.
The opaque enema was revised by the radiology unit, observing there was gas throughout the mesorectal space secondary to rectal perforation on the right side and to a 3 cm segment of stenotic sigmoid colon, reaching the barium the splenic flexure (Figure 1). Then the patient underwent a computed tomography (CT) which showed signs of uncomplicated diverticulitis and extramural gas surrounding the entire rectal ampulla with ascending projection to the sigmoid retroperitoneal fat with no abscesses or free fluid (Figure 2). The patient's clinical condition was mandatory and a conservative treatment with intravenous amoxicillin-clavulanate and a liquid diet were the options chosen. The patient progressed well and was discharged 4 days after her admission due to the clinical and radiographic signs of improvement, having lost most of the extraluminal air as observed on a control CT.