Colorectal perforation following anorectal manometry in a patient with anal stenosis post rectal prolapse repair: a rare complication

Anorectal manometry (ARM) is a valuable diagnostic modality for evaluating anorectal disorders. While rare, complications can occur including rectal perforation. We report a case of iatrogenic rectal perforation following ARM in a 77-year-old female with multiple prior rectal prolapse surgeries who was receiving chronic anticoagulation therapy. The patient developed rectal bleeding immediately post-procedure with subsequent imaging demonstrating retroperitoneal and mediastinal air. Flexible sigmoidoscopy revealed a 30% circumference rectal wall defect. Despite the extensive injury, the patient was hemodynamically stable without peritonitis. Conservative management consisting of bowel rest, broad-spectrum antibiotics resulted in complete resolution. Serial endoscopic evaluation confirmed full mucosal healing. This case demonstrates the importance of individualized procedural risk assessment in patients with prior anorectal surgery and underscores the feasibility of conservative management in stable cases of ARM-related rectal perforation.