Symptoms and Concerns of Fecal Peritonitis: What to Know

What are the possible symptoms of fecal peritonitis?

The patient is nearly 30 years old and has a history of internal hemorrhoids with rectal bleeding.
Yesterday, due to difficulty with bowel movements, they self-administered an enema purchased from a pharmacy and subsequently noticed fresh red blood in the stool.
Currently, the patient does not have any specific symptoms or pain.
After researching online, they learned that improper use of an enema could potentially lead to bowel perforation and fecal peritonitis.
Given the presence of fresh red blood in the stool, the patient is concerned.
Should they consult a proctologist or a gastroenterologist? Additionally, what are the possible symptoms of fecal peritonitis?

Kele, 20~29 year old female. Ask Date: 2009/12/11

Dr. Chen Qifeng reply Gastroenterology and Hepatology

Hello, the use of enemas is generally unlikely to cause bowel perforation leading to fecal peritonitis.
If this complication occurs, it often presents with severe abdominal pain requiring emergency surgery.
The presence of bright red blood in the stool after an enema is usually due to injury to the rectal mucosa during the procedure or often results from straining during bowel movements post-enema, which can cause hemorrhoidal bleeding.
If the bleeding is severe or persistent, an endoscopic examination is necessary to investigate the true cause of the bleeding.
Wishing you good health.
Sincerely, Dr.
Chen Chih-Feng, Taoyuan Hospital, Department of Health.

Reply Date: 2009/12/11

More Info

Fecal peritonitis is a serious condition that arises when fecal matter leaks into the peritoneal cavity, typically due to a perforation in the gastrointestinal tract. This can lead to severe inflammation and infection of the peritoneum, which is the lining of the abdominal cavity. Given the symptoms you've described, it's crucial to understand the potential implications and the appropriate steps to take.

First, the presence of bright red blood in the stool can indicate several conditions, ranging from hemorrhoids to more serious gastrointestinal issues. In your case, since you have a history of internal hemorrhoids, it's possible that the blood is related to that condition, especially if you have been experiencing straining during bowel movements. However, the use of an enema can sometimes lead to irritation or even injury to the rectal area, which could also cause bleeding.

While you mentioned that you currently do not have any other specific symptoms or pain, the concern about fecal peritonitis is valid, especially after using an enema. Symptoms of fecal peritonitis can include:
1. Abdominal Pain: This is often severe and may be accompanied by tenderness in the abdomen.

2. Fever: A high fever can indicate an infection.

3. Nausea and Vomiting: These symptoms may occur as the body reacts to the infection.

4. Changes in Bowel Habits: This could include diarrhea or constipation.

5. Abdominal Distension: The abdomen may appear swollen or bloated.

6. Signs of Shock: In severe cases, symptoms may progress to signs of shock, such as rapid heart rate, low blood pressure, and confusion.

Given your situation, it is advisable to seek medical attention promptly. You should consider visiting a gastroenterologist, as they specialize in conditions affecting the digestive system, including the intestines and rectum. They can perform the necessary examinations, such as a colonoscopy or imaging studies, to assess the state of your gastrointestinal tract and determine if there is any perforation or other serious issues.

In addition, if you experience any worsening symptoms, such as increasing abdominal pain, fever, or changes in your overall condition, you should seek emergency medical care immediately. These could be signs of a developing infection or other complications that require urgent intervention.

In summary, while your current symptoms may not seem alarming, the presence of bright red blood in your stool after using an enema warrants a thorough evaluation by a healthcare professional. A gastroenterologist will be able to provide the most appropriate care and determine whether further treatment is necessary. It's always better to err on the side of caution, especially when it comes to potential gastrointestinal complications.

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