Purpose
Spontaneous perforation of the colon is defined as a sudden perforation of the normal colon in the absence of diseases such as tumors,
diverticulosis or external injury.
It is rare,
often misdiagnosed and has a high mortality rate.
Peritonitis secondary to large bowel perforation due to colonic cancer or benign colorectal disease still remains a major clinical life-threatening condition associated with high morbidity and mortality.
CT findings of spontaneous colon perforationare seldom reported in the literature.
In this study,
we collected30 cases of spontaneous colon...
Methods and Materials
We retrospectively reviewed CT images and medical records of 45 cases of nontraumatic colonic perforations with histopathologically proven by surgery from May 2004 to April 2011.
Among 45 cases,
15 cases were excluded:
11 cases with perforated colon cancer;
2 case with bowel ischemia by TAE;
and 2 case with sigmoid colonic diverticulitis.
The rest 30 cases of 29 patients were spontaneous colonic perforations.
(one patient had two independent events.)
(M : F = 18 : 11,
Mean age: 68years,
range 39-92years)
We focused our...
Results
Clinical data
29 patients
- M : F = 11 : 18
- mean age : 68 years (range 39~92 years)
- Symptoms : a sudden lower abdominal pain in all patients
- Past medical history
chronic debilitating underlying diseases :12 patients (41.4%) - such as DM,
CRF,
CHF,
and Liver cirrhosis
constipation :4 patients (13.8%)
Past GI tract operation history: 5 patients (17.2%)
Pathologic examination
Confirmed as non-specific chronic or acute inflammation with colonic wall perforation
Accompanying necrosis,
acute serositis,
diffuse hemorrhage and vascular...
Conclusion
1.
All patient had extraluminal free-air and either focal colonic wall defects or fecal spillage.
2.
Sigmoid colon is the most frequent site of the spontaneous colonic perforation.
due to the special physiological and anatomical features of sigmoid colon
- no ramus anastomoticus between the lowest branch
of sigmoid arteries and the superior rectal artery
--> a physiological ischemia
3.
Patients are more fetal having necrosis(bowel ischemia) in pathology.
4.
Poor vascular supply and fecal impaction can be suggested main cause of spontaneous colon perforation....
References
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Krivanek S,
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Perforated colorectal cancer.
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Nespoli A,
Ravizzini C,
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The choice of surgical procedure for peritonitis due to colonic perforation....