Idiopathic Colonic Perforation in Adult—A Rare Case

Kurane, Sanjot B.; Kurane, Basappa T.

doi:10.1007/s12262-010-0127-z

Cited by 6 publications

(9 citation statements)

References 3 publications

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“…This type of perforation is probably derived from an increased colic pressure caused by fecalomas obstructing intestinal transit. The hard-impacted stools formed in the left colon perforate the recto-sigmoid colon by ischaemic necrosis [ 22 ]. This hypothesis is to be considered therefore unlikely.…”

Section: Discussionmentioning

confidence: 99%

Intestinal perforation after surgical treatment for incisional hernia: iatrogenic or idiopathic?

Amorosi

Longo

Sorotos

et al. 2018

Case Reports in Plastic Surgery and Hand Surgery

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Intestinal perforation (IP) is a life-threatening gastroenterological condition requiring urgent surgical care, which may present itself as an uncommon complication following incisional hernia repair surgery, most often because of iatrogenic traumatism occurring during the procedure. However, we report a case where a spontaneous onset can be hypothesised. A 60-years-old patient underwent repair of an abdominal laparocele, through rectus abdominis muscle plasty, 5 years after development of an incisional hernia due to exploratory laparotomy for the treatment of acute appendicitis. Xipho-pubic scar was excised and umbilicus and supra-umbilical hernia sac dissected, a linear median incision was performed along the sub-umbilical linea alba, reaching preperitoneal plane to assess any intestinal loop adherence to the abdominal wall. After limited viscerolysis, abdominal wall defect was corrected by ‘rectus abdominis muscle plasty’ and umbilicus reconstruction by Santanelli technique. Postoperative course was uneventful until Day 29, with sudden onset of epigastric pain, fever and bulge. Sixty cubic centimeter pus was drained percutaneously and cavity was rinsed with a 50% H2O2 and H2O V-V solution until draining clear fluid. Symptoms recurred two days later, while during rinsing presented dyspnoea. X-Ray and CT scan diagnosed IP, and she underwent under emergency an exploratory laparotomy, leading to right hemicolectomy extended to last ileal loops and middle third of the transverse, right monolateral salpingo-ovariectomy and a temporary ileostomy by general surgeon. Twenty-three days later an ileostomy reversal surgery was performed and 8 days after she was discharged. At latest follow-up patient showed fair conditions, complaining abdominal pain and diarrhoea, attributable to the extensive intestinal resection. IP following incisional hernia repair, is reported as uncommon and early postoperative complication. In our case, the previous regular postoperative course with late onset lead us to hypothesise a possible idiopathic etiopathogenesis, because of a strangulation followed by gangrene and abscess formation, which might begin before the incisional hernia repair and unnoticed at the time surgery was performed.

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Section: Discussionmentioning

confidence: 99%

Intestinal perforation after surgical treatment for incisional hernia: iatrogenic or idiopathic?

Amorosi

Longo

Sorotos

et al. 2018

Case Reports in Plastic Surgery and Hand Surgery

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“…One of the main reasons why SAIM has been overlooked is due to the low awareness of the disease among pathologists. In many studies, idiopathic perforation is defined as a perforation without an obvious clinical or pathologic cause, such as diverticulitis, ischemic colitis, infectious colitis, mechanical obstruction, nonobstructive colonic dilation, fecal impaction, and tumor 3–8,21. Indeed, all studies except for 121 include SAIM as the differential diagnosis of idiopathic perforation.…”

Section: Discussionmentioning

confidence: 99%

“…Other than infection, diverticulitis is the most common cause of colonic perforation 1,2. Although the cause of perforation can be identified in a relatively large proportion of cases, the precise etiology remains unknown even after in-depth clinical and pathologic examinations 3–8…”

mentioning

confidence: 99%

“…1,2 Although the cause of perforation can be identified in a relatively large proportion of cases, the precise etiology remains unknown even after in-depth clinical and pathologic examinations. [3][4][5][6][7][8] Segmental absence of the intestinal musculature (SAIM), also known as segmental muscular defect of the intestine, was first reported as a cause of neonatal intestinal obstruction by Emanuel et al 9 in 1967. Subsequently, SAIM has become a distinctive disease entity when dealing with an acute abdomen in newborns.…”

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confidence: 99%

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Prevalence and Clinicopathologic Features of Intestinal Perforation Caused by Segmental Absence of the Intestinal Musculature in Adults

Tsuyuki

Satou

Takahara

et al. 2021

American Journal of Surgical Pathology

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Segmental absence of the intestinal musculature (SAIM) can cause intestinal perforation in adults. However, its prevalence and clinicopathologic features have not been well-described. This study aimed to determine the prevalence of SAIM-associated perforation and characterize its clinicopathologic features. We retrospectively examined 109 cases of intestinal perforation that underwent surgical resection from January 2009 to December 2019. SAIM was defined as the complete absence of the muscularis propria without extensive inflammation and fibrinous exudation around the perforation. SAIM was the second most frequent cause of perforation (26 cases: 24%), the most frequent cause being related to diverticulitis (39 cases: 36%). The most common site was the sigmoid colon (12 cases: 46.2%). The younger group (aged below 65 y) exhibited more frequent perforation of the upper segments of the gastrointestinal tract (from the duodenum to the descending colon) than the older group (65 y and above) (P=0.0018). No patients developed recurrence. The most common gross features were well-defined circular or small punched-out lesions, and the histologic features were complete absence of the muscularis propria and absence of hemorrhage and necrosis around the area of perforation. The characteristic features of SAIM were unique and their prevalence was higher than previously reported. The precise recognition of SAIM can aid in understanding the cause of perforation and avoiding further unnecessary examinations.

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“…Complicated diverticulitis and colorectal cancer are the most common causes . However, several benign etiologies should be taken into account except for trauma perforation (which include iatrogenic perforations, blunt abdominal trauma, and stab wounds) excluded by clinical history, Necrotic acute pancreatitis, ulcerative colitis, stenosis of colorectal anastomosis with obstruction and idiopathic large bowel perforation are rarely mentioned (5.1%) . Hepatic and intestinal schistosomiasis is the most common form of the chronic disease and usually results from heavy Schistosoma mansoni infection .…”

Section: Discussionmentioning

confidence: 99%

Systemic schistosomiasis and large bowel perforation: An unexpected surgical urgency. Report of a case and literature review

Agrusa

Buono

Buscemi

et al. 2019

Clinical Case Reports

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Idiopathic Colonic Perforation in Adult—A Rare Case

Cited by 6 publications

References 3 publications

Intestinal perforation after surgical treatment for incisional hernia: iatrogenic or idiopathic?

Intestinal perforation after surgical treatment for incisional hernia: iatrogenic or idiopathic?

Prevalence and Clinicopathologic Features of Intestinal Perforation Caused by Segmental Absence of the Intestinal Musculature in Adults

Systemic schistosomiasis and large bowel perforation: An unexpected surgical urgency. Report of a case and literature review

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