Abstract
A 58-year-old man had been bedridden due to the long-term sequelae of cerebral infarction. Loss of appetite, constipation and weight-loss were present for two weeks prior to presenting at the hospital for disturbance of consciousness. Abdominal X-ray and computed tomography revealed large quantities of free intraperitoneal gas but no signs of peritoneal irritation were observed. Emergency surgery was performed under the strong suspicion of gastrointestinal perforation. On laparotomy, findings of peritonitis were limited and a pinhole perforation was observed in the sigmoid colon. No visible lesions were present in the perforated region and idiopathic perforation of the colon was diagnosed. Surgery comprised suture closure of the perforation, peritoneal lavage and drainage. Idiopathic large intestine perforation often takes a critical course accompanied by fecal peritonitis; however, the present patient was a rare case in which no symptoms of peritonitis were present and severe illness was avoided as only gas had leaked into the peritoneal cavity from the small perforation.
