Spontaneous rupture of the bowel

Abstract

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 ...

Spontaneous perforation of the rectum with possible stercoral etiology: Report of a case and review of the literature

“…On the other hand, in idiopathic perforation, a linear laceration of the antimesenteric side of the colon without any remarkable pathologic change in the colon wall is frequently located in the sigmoid colon. 3,5 One report indicated the typical sites of spontaneous perforation of both stercoral and idiopathic etiology as follows: in the anterior wall of the rectum just proximal to the peritoneal reflection; in the antimesenteric border at the rectosigmoid junction; and in the apex of the sigmoid loop on the antimesenteric side. 6 This information supports a diagnosis of stercoral perforation in our patient.…”

“…In 1962, Noussias classified spontaneous perforation into stercoral perforation and idiopathic perforation on the basis of causes of the lesions. 3 Stercoral perforation may feature chronic constipation and hard stools as part of its cause, whereas idiopathic perforation should not show evidence of pressure necrosis or ulceration. Spontaneous perforations, while they may occur at sites where carcinoma, diverticular disease, or even stercoral ulcers exist, should occur spontaneously, that is, in the absence of trauma or a Valsalva maneuver.…”

Rupture of Rectosigmoid Colon with Ileal Prolapse Through Anus

“…The mortality quoted by Minkari and Turan (1961) is 85% compared with 30% in Noussias's (1962) series. The former report, however, includes many cases from the pre-antibiotic era of surgery.…”

“…It has been repeatedly recorded-25 out of 41 cases collected by Noussias (1962)-that constipation is often found in patients suffering " spontaneous perforation " of the colon. Thus faecal peritonitis is a real hazard.…”

Idiopathic Bowel Rupture

“…Cronin (1959) states that “the term spontaneous is found to be used synonymously with idiopathic”. Noussius (1962) drew attention to this and stated that “it would not seem unreasonable to use the term ‘idiopathic rupture’ for those cases without local demonstrable pathology and to use the term ‘spontaneous rupture’ for those in which some other lesion is found”. This seems reasonable seeing that the management will differ in the two groups and for scientific classification accuracy is essential.…”