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World J Gastroenterol. Jul 28, 2008; 14(28): 4569-4572
Published online Jul 28, 2008. doi: 10.3748/wjg.14.4569
Diagnosis and treatment of spontaneous colonic perforation: Analysis of 10 cases
Bo Yang, Huai-Kun Ni
Bo Yang, Huai-Kun Ni, Department of General Surgery, City Hospital of Fuding, Fuding 355200, Fujian Province, China
Author contributions: Ni HK and Yang B contributed equally to perform all surgical cases; Ni HK designed research; Ni HK and Yang B performed research; Ni HK analyzed data and wrote the paper.
Correspondence to: Huai-Kun Ni, Department of General Surgery, City Hospital of Fuding, Fuding 355200, Fujian Province, China. 821554100@qq.com
Telephone: +86-593-7832030
Fax: +86-593-7862665
Received: May 18, 2008
Revised: June 16, 2008
Accepted: June 23, 2008
Published online: July 28, 2008
Abstract

AIM: To investigate the etiology, diagnosis and treatment of spontaneous perforation of the colon.

METHODS: The clinical data of 10 cases of spontaneous perforation of the colon, observed at Fuding hospital from January 2004 to December 2007, were analyzed retrospectively.

RESULTS: The mean age at onset was 65 years (range from 45 to 73). Seven patients had a history of chronic constipation. All patients complained of sudden lower abdominal pain. The perforation occurred after coloclysis and administration of senna leaves in two patients. Nine patients had signs of peritoneal irritation. Seven cases underwent abdominal paracentesis, which was diagnostic in six. Only one case was definitely diagnosed prior to surgery. One patient underwent neoplasty of the colon, another a partial resection of colon, six a neoplasty of the colon plus sigmoid colostomy, and two underwent Hartmann surgery. All perforation sites were opposite to the mesenteric edge. The perforation sites were located on descending colon in one case, sigmoid colon in three cases, and rectosigmoid colon in six cases. In five patients, surgical pathological examination was consistent with the microscopical changes of colonic perforation caused by feces. Three patients died after surgery.

CONCLUSION: 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.

Keywords: Spontaneous; Perforation; Colon; Treatment; Surgery