Idiopathic perforation of the sigmoid colon in Japan

Abstract

This is a report of a case of idiopathic perforation of the sigmoid colon, a rare condition, and a review of 65 cases collected from the Japanese literature including our own. The ratio of males to females was 42∶23, the ages ranged from 16 to 87 years, and 68% of the patients were in the sixth decade or older. The perforation sites were in the middle of the sigmoid colon in 43 cases, of which 79% were at the antimesenteric border, and in the rectosigmoid region in 2 cases. Several pathogenetic factors are considered to be responsible for this perforation, among which constipation and raised intra-abdominal or intraluminal pressure may be most important. In the cases associated with constipation, differential diagnosis must be made by histologic examination. Free air under the diaphragm was noted on x-ray in 46% of patients and leukopenia under 4000/mm ³ in 35% of the cases. Only 2 patients with confined perforation were diagnosed preoperatively by barium enema x-rays. The overall mortality rate was 35%. Exteriorization or resection of the perforated site resulted in the best prognosis among the various operative procedures. There were 5 instances of colocutaneous fistula in 13 patients who underwent simple closure of the perforation.