How to diagnose and treat spontaneous colonic perforation?

Spontaneous perforation of the colon is defined as a sudden perforation of the normal colon without any diseases such as tumor external injury. It is rare, often misdiagnosed and has a high mortality rate. A group led by Huai-Kun Ni from Fuding City Hospital of China investigated the etiology, diagnosis and treatment of spontaneous perforation of the colon, and this will be published on July 28, 2008 in the World Journal of Gastroenterology.

They retrospectively analyzed the clinical data of 10 cases of spontaneous perforation of the colon, observed at Fuding hospital from January 2004 to December 2007. 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. This study may be helpful for the diagnosis and treatment of spontaneous colonic perforation.

Reference: Yang B, Ni HK. Diagnosis and treatment of spontaneous colonic perforation: An analysis of 10 cases. World J Gastroenterol 2008; 14(28): 4569-4572 http://www.wjgnet.com/1007-9327/14/4569.asp

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

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