Caecal rupture due to colonic ileus

Abstract

Caecal rupture due to colonic ileus is rare and has a mortality rate of 43 per cent. Three new cases are presented and the 18 previously reported cases are reviewed. The disease has always occurred in association with another illness, has usually afflicted patients over the age of 55 and has only resulted when the caecum was at least 9 cm in diameter. The technique of 'blow-hole' caecostomy, a method for decompressing the distended caecum, is described.

Colonic ileus

“…B Barium enema study four days later demonstrates cecal perforation, with extravasation up the paracolic gutter to the subhepatic space mechanical obstruction of the colon, Lowman and Davis [13,14] stressed the possibility of cecal necrosis and perforation when the cecal diameter reaches 9 cm. In the instance of cecal rupture due to colonic ileus, the cecal diameter has always been 9 cm or larger, ranging from 9 to 20 cm [12]. However, the fact that the cecum may remain distended to diameters of 14 to 18 cm for a few days in colonic ileus without inevitable perforation is supported by our series.…”

“…Over 20 cases of cecal perforation in severe or protracted colonic ileus with a mortality rate of 43% have been described [5,7,11,12]. These were probably attributable to delay in recognition of the cecal necrosis as well as of the primary disease state.…”

“…Cecostomy was performed in two of our patients. When a short term of conservative therapy is unrewarding, or cecal distention reaches a 9 cm diameter, or right lower quadrant symptoms or findings develop, operative decompression by cecostomy has been advocated to prevent peritonitis [5,12,19].…”

Spontaneous pneumothorax: are we missing something?

“…Among the above-mentioned respiratory abnormalities, the incidence of spontaneous pneumothorax is about 5% in such cases [1], while colon perforation is reported to be a rare complication of a non-typical undiagnosed syndrome [2,3]. In these cases despite the meticulous exploration during laparotomy, a causing factor-diverticulitis, luminal bowel obstruction, incarcerated hernia, intussusception or volvulus-cannot be identified.…”

Acute Colonic Pseudo-Obstruction: Rapid Correction with Neostigmine in the Emergency Department

“…For example, a review of over 400 cases of colonic pseudo-obstruction found no perforations at a cecal diameter Ͻ 12 cm, a 7% rate for diameters of 12-14 cm, and a 23% rate for Ͼ 14 cm (21). Other reports confirmed a cecal diameter of 12 cm as the starting level for an increasing risk of perforation (22)(23)(24)(25). In deciding on an initial strategy, the clinician must weigh the benefits of conservative treatment vs. the potential for perforation.…”