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Study design:Case report.Objectives:Report a case of rectum perforation during transanal irrigation (TAI).Setting:Clinic for Spinal Cord Injuries, and Departments of Gastroenterological Surgery and Radiology.Case report:A 54-year-old woman with spinal cord lesion for 35 years emptied for years her bowel using oral laxative. This became more difficult and took more than 2 h three times a week with reflex stimulation after a chlysma. She wanted to try TAI, and went through the procedure with a nurse one time. The next time she performed the TAI by herself without difficulty. Two hours later she started shivering with a temperature at 38.3 °C with normal blood pressure (BP). At rectal exploration, a spoonful fresh blood was found. After another 2 h, she became septic and was transferred to a gastroenterological surgical department. An abdominal X-ray gave no suspicion of free air in the abdomen. Sigmoideoscopy showed 3–5 cm oral to the dentate line a 1 × 1 cm transmural circular lesion. A colon X-ray with water contrast showed a perforation of approximately 2 × 0.5 cm.Conclusion:Even in experienced individuals who are proper trained, TAI can cause rectal perforation, which always have to be born in mind.Spinal Cord (2009) 47, 266–267; doi:10.1038/sc.2008.95; published online 5 August 2008 [ABSTRACT FROM AUTHOR]