Colonic Perforation Secondary to Idiopathic Intramural Hemorrhage

Sakamoto, Takashi; Saito, Akira; Lefor, Alan Kawarai; Kubota, Tadao

doi:10.3393/ac.2016.32.6.239

Cited by 5 publications

(5 citation statements)

References 7 publications

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“…A literature search was conducted on the research database (MEDLINE) for all articles published in English from 1998 to 2017. MEDLINE retrieved 39 case reports, 7 , 10 – 47 including 46 patients, and four case series including 175 patients. 1 , 2 , 5 , 48 To this end, a total of 228 patients with SCPA were identified ( Figure 1 ).…”

Section: Methodsmentioning

confidence: 99%

Spontaneous colonic perforation in adults: Evaluation of a pooled case series

et al. 2020

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Spontaneous colonic perforation in adults (SCPA) is rare but important. Its clinicopathological features and outcomes remain unclear. Therefore, the aim of the current study was to explore and investigate the clinicopathological characteristics, clinical outcomes and potential risk factors for patients with SCPA. Data of seven patients with SCPA treated in our hospitals from January 2008 to December 2017, and 221 cases from research databases before 2018 were retrospectively analyzed. The description of SCPA included stercoral perforation of the colon (SPC), idiopathic perforation of the colon (IPC) and spontaneous colonic perforation (SCP) in the study. All SCPA patients presented with unexplained abdominal pain and peritonitis. The median age was 62.5 years. The definite diagnosis preoperatively was 20.6%. The commonest lesion location was sigmoid colon and Hartmann’s operation accounted for 59.3%. Histopathology of stercoral perforation (HSP) and histopathology of idiopathic perforation (HIP) were two histopathological findings. Postoperative complication was 67.7% and mortality was 31.1%. Univariate and multivariate analyses showed that chronic constipation was an independent risk factor for histopathological features ( p ≤ 0.001, p = 0.005). Age of patients was associated with both postoperative complication ( p = 0.012, p = 0.044) and mortality ( p = 0.013, p = 0.034). Univariate analysis showed that HSP was associated with postoperative complication ( p = 0.015). Our findings from the analysis pertaining to SCPA confirm those from previous studies, supporting the SCPA, as a uniform description, is an infrequent and life-threatening disease requiring early surgical intervention. We found that the elderly with chronic constipation was a high-risk category and those with HIP had a more favorable outcome than that of patients with HSP.

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Section: Methodsmentioning

confidence: 99%

Spontaneous colonic perforation in adults: Evaluation of a pooled case series

et al. 2020

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“…Moreover, there are various scenarios where it may be necessary to perform a colectomy. For instance, an urgent laparotomy with right hemicolectomy was performed in the setting of large bowel hematoma resulting in colonic perforation [ 8 ]. Another case reports a patient with both colonic adenocarcinoma and an intramural hematoma indicating right hemicolectomy to manage both diagnoses [ 6 ].…”

Section: Discussionmentioning

confidence: 99%

Giant Proximal Right Colon Submucosal Hematoma Leading to a Large Bowel Obstruction

Siddiqui¹,

Ahmed²,

Nazim³

et al. 2022

Cureus

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A 41-year-old female with a previous history of chronic obstructive pulmonary disease (COPD) and polycythemia presented to the emergency department with worsening shortness of breath and cough which progressed to respiratory distress requiring mechanical ventilation. During her hospital stay, she developed abdominal distention followed by a fever and a four-point decrease in hemoglobin. A non-contrasted abdominopelvic CT scan was ordered which showed a very large retroperitoneal hematoma adjacent to the right colon with subtle active bleeding. Selective angioembolization of a distal segment of the right colic artery was performed by Interventional Radiology (IR) to achieve hemostasis and hemodynamic stability. Due to the persistent and worsening abdominal distention, a CT scan with contrast was ordered which clearly showed a submucosal hematoma in the region of the right colon extending from the hepatic flexure to the cecum. The hematoma was completely obstructing the proximal and mid ascending colon leading to a large bowel obstruction. Exploration of the abdomen showed severe bowel dilation, and frank ischemia of the hepatic flexure of the colon. Right hemicolectomy with primary ileocolonic anastomosis to evacuate the right retroperitoneal hematoma was subsequently performed. The patient was discharged on post-operative day 16 with no major complications.

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“…Idiopathic cases, with unknown or uncertain origin, have also been described but their occurrence has been reported in less than 5% of cases [2,8,[15], [16], [17], [18], [19], [20]]. Intramural hematoma may occur from esophagus to rectum [17], being the duodenum the most common site [19,21]. Intramural isolated hematoma of the colon is a very rare disease [16,22], much less frequent than hematoma in other segments of gastrointestinal tract [[23], [24], [25]].…”

Section: Discussionmentioning

confidence: 99%

“…An urgent laparotomy with right hemicolectomy was performed. Histologic examination showed an intramural bleeding that caused wall ischemia and subsequent perforation [19].…”

Section: Discussionmentioning

confidence: 99%