An unusual case of caecal perforation following ileostomy reversal

Abstract

A 63-year-old man with a history of gastro-oesophageal reflux disease underwent defunctioning loop ileostomy for obstructing metastatic rectal cancer prior to receiving long-course neoadjuvant chemoradiotherapy. Four months post completion of neoadjuvant therapy, he underwent an uncomplicated elective ultra-low anterior resection with formation of colonic J pouch and first stage liver metastasectomy for bilobar liver disease. At 1 year, he proceeded to an elective closure of loop ileostomy. Unfortunately, his postoperative course was complicated by profuse diarrhoea with subsequent colonic perforation, necessitating an emergency laparotomy and ileocolic resection with end ileostomy formation. Histopathology and stool studies were consistent with Salmonella Typhi infection. At the present time, Salmonella Typhi causing toxic megacolon and subsequent colonic perforation is an uncommon phenomenon in Australia. Here, we present an unusual case and explain why bowel perforation in this instance likely had a multifactorial aetiology.

Toxic megacolon due to Salmonella acute infectious colitis requiring total colectomy following loop ileostomy closure

“…Diverting loop ileostomy is a procedure which is commonly formed to divert the faecal stream from distal colonic disease or anastomosis. They are commonly formed following low rectal anastomoses to prevent septic complications in the event of an anastomotic leak 1,2 . Closure of the loop ileostomy is usually completed after at least 3 months post‐formation 3 .…”

“…They are commonly formed following low rectal anastomoses to prevent septic complications in the event of an anastomotic leak. 1,2 Closure of the loop ileostomy is usually completed after at least 3 months post-formation. 3 Commonly reported ANZJSurg.com complications of closure of loop ileostomy include anastomotic leak, wound infection, incisional hernia, ileus and bowel obstruction.…”