We present a case of a 34-year-old male with an intra-peritoneal rectal perforation from a rectal foreign body. He presented more than 24 hours after the case from an outside hospital, with abdominal pain, rectal bleeding, and pain with bowel movements. On initial CT there was evidence of free air and pelvic free fluid. He was stable with no other injuries. He was taken to the operating room. A Hasson technique was utilized for entry. Five ports were ultimately placed, with a 5 mm left upper quadrant port, a 5 mm right upper quadrant port, 5 mm suprapubic port and a 12 mm disposable trocar in the right lower quadrant. The patient then underwent a laparoscopic primary repair of a longitudinal tear just at the anterior peritoneal reflection in a single layer fashion with interrupted 2-0 PDS sutures. We utilized the transanal endoscopic microsurgery (TEM) beads (Wolf, TM) to secure the sutures, resulting in a fast and easy repair in the deep pelvis. The patient was diverted with a loop colostomy. He did well post operatively, with no leak on CT with rectal contrast 3 months later.

This video demonstrates the feasibility and principles of laparoscopic repair of rectal perforation, as well as the novel application of TEM beads for securing the sutures.