Spontaneous perforation of the normal pelvic colon

Kirkham, C. S.

doi:10.1002/bjs.18004820804

Cited by 18 publications

(10 citation statements)

References 8 publications

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“…Eadie (1955) suggested that the colon in such cases is more liable to rupture with a lower intra-intestinal pressure than the normal bowel. Such cases have been reported by Cronin (1959) and Berger and Shaw (1961), but Kirkham (1960) states that in I of his cases, although there was an area of abnormal thinness of the muscle-coat, "rupture of the bowel occurred not at this point but above it, where the wall was normal". However, in most of the other cases a barium enema, after recovery, revealed nothing abnormal, not even the early stage of diverticulosis.…”

Section: --T H E B R I T I S H J O U R N a L O F S U R G E R Ymentioning

confidence: 80%

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Spontaneous rupture of the bowel

Noussias¹

1962

Journal of British Surgery

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THE term 'spontaneous rupture' is accepted by the majority of authors to define perforation which occurs in an apparently normal bowel without any obvious cause. Several writers, however, include under this expression perforation occurring in association with other pathological conditions. Woodruff (1952), for example, reported 14 cases of perforation due to diverticulitis or carcinoma, and Levin and Isaacson (1960) stated that in I of their cases the histological examination showed fungal infection at the site of perforation.I t would seem preferable to distinguish spontaneous rupture associated with an obvious pathological lesion from that occurring in the absence of any recognizable cause, not only in order to avoid confusion but also because the management differs in each of these two groups. In the latter the term ' spontaneous ', as Cronin (1959) says, " has often been thought to be synonymous with idiopathic". Thus, it would seem not unreasonable to reserve the expression 'idiopathic rupture ' for those cases without other demonstrable local pathology and to use the term 'spontaneous rupture' for those in which some other lesion is found.T h e mechanism of rupture in a normal bowel and the aetiological factors implicated have been the subject of much discussion by different authors. Although several theories have been suggested, the precise mechanism of rupture is not yet well known and in some reported cases there is no satisfactory explanation.The purpose of this paper is to present 2 cases of such perforations and to discuss the condition with particular reference to its aetiology. Attention is also drawn to a new suggestion regarding the possible mechanism in a small number of cases. CASE REPORTSCase I.-L. B., a woman aged 75 years, was admitted to hospital on Sept. 16, 1961, as an abdominal emergency. She was complaining of severe lower abdominal pain of about 7 hours' duration. The onset was sudden, without any muscular effort or other violence, and without apparent cause. Gradually the pain became worse and spread all over the abdomen. There was no vomiting. Before the pain began she had two normal, soft motions. The patient gave a past history of intermittent diarrhoea and slight dyspepsia of 5 months' duration. She had had a right oophorectomy 35 years previously, and had subsequently given birth to a child.her temperature was 98" F., pulse-rate IOO per minute, and respiratory rate 30 per minute. Her blood-pressure was 130/7o. The tongue was furred, the abdomen not distended, but there was diffuse tenderness and rigidity, throughout. Bowel-sounds were present. Rectal examination revealed tenderness in the pouch of Douglas with a few scybalous faxes. There was no hernia. The clinical picture was suggestive of peritonitis and laparotomy was performed.AT OPERATION.-The abdomen was opened through a lower midline incision. Thin, purulent fluid and a ON EXAMINATION.-The patient looked acutely ill; considerable quantity of formed fzces were found in the peritoneal cavity. After these had been removed, a ...

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Section: --T H E B R I T I S H J O U R N a L O F S U R G E R Ymentioning

confidence: 80%

“…Twentynine of these patients were male and 10 female. The youngest was 17 years of age (Sicard, Picard, and Lachrtre, 1956), and the oldest 76 years (Kirkham, 1960). With regard to the mechanism of rupture several authors have emphasized the significance of constipation, of a rise of intra-abdominal pressure, and of the presence of inguinal herniae.…”

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confidence: 99%

Spontaneous rupture of the bowel

Noussias¹

1962

Journal of British Surgery

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“…To the best of our knowledge, our patient is the first case to be reported involving three colonic perforations; however, one report described a case in which an intestinal rupture occurred twice after an interval of 3 years. 14 In conclusion, a barium ball after an upper GI series may have possibly contributed to a stercoral perforation of the colon in one case, while another case suggests that a colonic perforation may occur several times in the same patient.…”

Section: Discussionmentioning

confidence: 95%

An Unusual Perforation of the Colon: Report of Two Cases

et al. 2002

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We herein present two cases of a colorectal perforation due to uncommon reasons. First, we treated a 45-year-old woman for a stercoral perforation of the sigmoid colon. The pathognomonic etiology was a barium fecaloma originating from an upper gastrointestinal series 9 months before admission. The second case was a 46-year-old woman who was admitted with a perforation of the transverse colon. She had experienced perforations of the sigmoid colon at 32 years of age and of the rectum at 44 years of age, respectively. The second and third conditions were diagnosed to be idiopathic, and were histologically proven by an abrupt obliteration and a thinness of the colonic wall with some infiltration of inflammatory cells. The first condition, however, was most likely a stercoral perforation. The postoperative course of these patients was uneventful, and both are doing well at this writing.

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“…However, rupture of apparently normal bowel in the presence of diverticulosis is well documented (Berger and Shaw, 1961). It usually occurs on the less vascular antimesenteric border (Brearley, 1954) where diverticula are less common (Kirkham, 1960), and is said to be the result of ischaemic stercora! ulceration and necrosis associated with constipation.…”

Section: Discussionmentioning

confidence: 99%

“…There may be a sudden increased intraluminal pressure in the hollow viscus without corresponding rise in pressure outside; this may result from direct trauma (Aird, 1937), indirectly from muscular effort in patients with hernias (Bunge, 1905; Haim, I~IO), or the pelvic floor may be the locus minoris resistentiae of the abdominal parietes (Wilensky and Kaufman, 1937). Congenital or aquired defects (e.g., diverticulosis) may also weaken the bowel wall (Kirkham, 1960), which may rupture with normal or increased intraluminal pressures. I n many cases of spontaneous rupture of the alimentary canal a history is elicited of constipation (Berger and Shaw, 1961), alkali medication (Brearley, 1g54), and associated straining (e.g., at stool or during micturition).…”

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confidence: 99%

Perforation of the sigmoid colon resulting in subcutaneous emphysema of the head and neck and associated pneumoperitoneum

Maw

1968

Journal of British Surgery

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Spontaneous perforation of the normal pelvic colon

Cited by 18 publications

References 8 publications

Spontaneous rupture of the bowel

Spontaneous rupture of the bowel

An Unusual Perforation of the Colon: Report of Two Cases

Perforation of the sigmoid colon resulting in subcutaneous emphysema of the head and neck and associated pneumoperitoneum

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