Diagnosis and treatment of spontaneous colonic perforation: Analysis of 10 cases

Abstract

Spontaneous perforation of the colon most commonly occurs among the elderly with chronic constipation. Abdominal paracentesis is helpful for the diagnosis. The perforation site is located opposite to the mesenteric edge. Sigmoid colon and rectosigmoid colon are the most frequent locations. Neoplasty of the colon and sigmoid colostomy are the most frequent treatment. The prognosis is bad and the mortality rate after surgery is high.

A Case Report of Ascending Colon Perforation in A Diabetic Patient

“…The disease has often been seen in patients with chronic constipation. Stercoral perforation is common in sigmoid (Sudeck's point), rectosigmoid regions [3] . This is due to the physiological ischemia because there is no anastomosis between the lowest branch of sigmoid arteries and the superior rectal artery.…”

“…It occurs more often in rectosigmoid, cecum, transverse and descending colon [4] . Two hypotheses have been proposed to explain idiopathic perforations: Vascular theory which suggests combination of hypoperfusion of colonic tissue & constitutional weakness of the bowel wall with increased intraluminal pressure which may be due to intestinal hernia, rectal prolapsed [3] . Second theory proposes asymmetrical distribution of intraluminal pressure at the pelvi-rectal angle in absence of obvious impacted stool or any identifiable cause of perforation.…”

“…Both entities are infrequently diagnosed preoperatively and are associated with a high mortality rate. [3] Stercoral perforation begins with ulcerative lesion in colon which progresses to a "round" or an "ovoid" hole with necrotic and inflammatory edges [3] . The disease has often been seen in patients with chronic constipation.…”

“…Intraoperatively, it is difficult to distinguish between types of perforation so, surgical pathological examination is necessary to make a definite diagnosis. The principle of management of SPC is prompt surgical intervention, excision of the affected segment and extensive peritoneal lavage with antibiotics [3] . Primary repair with proximal loop ileostomy was the treatment of choice in our case as the perforation was large and located on ascending colon.…”

Idiopathic Colonic Perforation in Adult—A Rare Case

“…Several pathogenetic factors are considered responsible for idiopathic perforation of colon, like constipation, raised intra-abdominal pressure/ intraluminal pressure etc, but nothing has been proved yet [4]. Idiopathic colonic perforation usually is linear, with broken ends of muscular layer regular, and histology is normal [5].…”