Non-traumatic Perforation of Colon: A 5-year Retrospective Study at Uthaithani Hospital
Keywords:
non-traumatic perforation of colon, etiologies, suspicious diagnosis, mortalityAbstract
Background: Non-traumatic perforation of colon is a fatal surgical emergency that confronts withserious risks and high mortality influenced by leakage of several types of virulent bacteria inside the colon. This
condition has various etiologies, which is difficult for accurate preoperative diagnosis, causing a problem for
surgical decision.
Objective: We aimed to study the etiologies and the difficulties in diagnosis and management of this
condition in our rural area and to identify factors related to mortality.
Materials and Methods: A retrospective study was conducted by reviewing medical records of patients
with non-traumatic perforation of colon undergoing surgery during October 2004 and September 2009. The data
were analyzed by using the statistics of number, percentage, mean, standard deviation, Chi-square, Fisher’s
extract and independent T-test.
Results: Forty two patients (20 males, 22 females) with non-traumatic perforation of colon were included
in this study. The mean age was 59.3 ± 14.3 years (range 35-86). The mean duration of symptom to surgery was
34.3 ± 21.2 hours and the length of hospital stay was 11.02 ± 6.4 days. The most common presenting symptoms
and signs were abdominal pain (97.6 %) and abdominal distension (95.2 %) respectively. Pneumoperitoneum
was presented in 13 of 39 patients (33.3 %) by plain abdominal radiograph and ultrasonography was performed
to confirm positive diagnosis in 83.3 % (10/12). The provisional diagnosis that was recorded was similar to the
definitive diagnosis in 38.1 % (16/42). Sigmoid colon was the most common perforated site. Main operative
procedure was simple suture perforated wounds with proximal loop colostomy. The most common etiology was
ingestion of fruit seeds especially during its harvest season. Postoperative complications were bowel fistula,
wound infection and dehiscence. There were 12 deaths which are due to underlying diseases, renal impairment
and sepsis shock due to intra-peritoneal soiling (p-value ≤0.005).
Conclusion: Non-traumatic perforation of colon at Uthaithani Hospital commonly occurred in the
elderly patients over 50 years of age. The main etiologies were ingestion of fruit seeds and ruptured
diverticulitis. In this report it was revealed that the adjuvant tools of high suspicious indexes for this diagnosis
were history of fruit seed ingestion, abdominal pain, distension and fever. To confirm diagnosis, the use of plain
radiography and ultrasonography of the abdomen was suggested as selected tools. It also showed that mortality
may be related to underlying diseases of patients and sepsis status due to feces-contaminated intraabdomen.
References
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Sandorica Seed. J Med Assoc Thai 2001;84:1751-3.
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Abdominal CT finding in non-traumatic colorectal
perforation. Euro J Radio 2008;65:125-32.
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disease of the colon. Adv Surg 1978;12:85-109.
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Brehant O, et al. Primary anastomosis after intraoperative
colonic lavage vs. Hatmann’s procedure in peritonitis
complicating disease of colon. Int J Colorectal Dis 2003;18:
503-7.
blunt abdominal trauma: results of the EAST Multi-Institutional
Hollow Viscus Injury Study. J Trauma 2003;55:906-12.
2. Chappius CW, Dietzen CD, Panetta TP, Beuchter KJ, Cohn I.
Management of penetrating colon injuries : a prospective
randomized trial. Ann Sug 1991;213:492-8.
3. Mayer C, Rochas M, Rohr S, Eynard H, Hollender LF.
Perforation of colon. Apropos of 74 cases. J Chir (Paris )1989;
126:5011-6.
4. di Nattale I, Tessarin M, Sartori CA, Patelli G, Dal Pos R, Sorato
R, el al. Non-traumatic colonic perforation in free perinonium:
Apropos of 61 cases. Minerva Chir 1989;44:1981-4.
5. Yilmazlar T, Toker S, Zorluoglu A. Non-traumatic colorectal
perforation. Int Surg J 1999;84:155-8.
6. Harsanyi M. Rozsos IE, Tako C, Szporny G. Perforation of
sigmoid colon by a foreign body and its urological
consequences. Br J Urol 1996;77:325-6.
7. Fujikawa T, Matsusue S, Nishimura S,Takakuwa M. “Pseudo-
Phytobezoar” due to seed from pickled plum resulting
perforated peritonitis. Am J Gastroenterol 1999;94:3373-4.
8. Somboonpanya P. Sigmoid Colon Perforation by Ingested
Sandorica Seed. J Med Assoc Thai 2001;84:1751-3.
9. Rivka Z, Marjoree H, Alexandra O, Eninet E, Gabriela G.
Abdominal CT finding in non-traumatic colorectal
perforation. Euro J Radio 2008;65:125-32.
10. Mahmoud N, Rombeau J, Ross HM, Fry RD. Colon and
rectum. In: Townsend CM, Beauchamp RD, Evers BM,
Mattox KL, editors. Sabiston Text book of Surgery, 17th ed.
Philadelphia: WB Saunders; 2004. p. 1219-39.
11. Bullard KM, Rothenberger DA. Diverticular disease. In:
Brunicadi FC, Anderson DK, Billiar TR, Dunn DL, Hunter JG,
Pollock RE. (eds) Schwartz’s Manual of Surgery, 8th ed. New
York: McGraw-Hill; 2005. p. 748-50.
12. Hinchey EJ, Schaal PG, Richards GK. Treatment of diverticulitis
disease of the colon. Adv Surg 1978;12:85-109.
13. Regnet N, Pessaux P, Hennekinne S, Lermitte E, Tuech JJ,
Brehant O, et al. Primary anastomosis after intraoperative
colonic lavage vs. Hatmann’s procedure in peritonitis
complicating disease of colon. Int J Colorectal Dis 2003;18:
503-7.
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Published
2009-12-30
How to Cite
1.
Suradom C, Sombunphulphipat P, Keawkaseadkorn S. Non-traumatic Perforation of Colon: A 5-year Retrospective Study at Uthaithani Hospital. Thai J Surg [Internet]. 2009 Dec. 30 [cited 2024 Dec. 23];30(3-4). Available from: https://he02.tci-thaijo.org/index.php/ThaiJSurg/article/view/227800
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