A Case Report on the Perforation in a Diverticulum in the Colon Located Between Two Stomas in a Long-term Prednisolone Patient

Abstract

A 70-year-old woman who had chronic hypersensitivity, pneumonitis and Myasthenia Gravis had been taking prednisolone for a long time. Four years previously, she had undergone Hartmann surgery and descending colostomy because of perforation with a diverticulum in the sigmoid colon. Six months later, a double transverse colostomy was performed because of severe abscess formation around the descending colostomy. She was admitted to our hospital with left upper abdominal pain. The abdominal CT showed diverticulitis in the descending colostomy and free air under the left diaphragm. We diagnosed perforation and generalized peritonitis in the colon, and performed an emergency operation. A 5mm perforation had occurred in a diverticulum in the mesentery contralateral to the descending colon located between two stomas. Resection of the descending colon, and a descending colostomy closure were performed. As the reason for the perforation in this case, weakening of the descending colon wall was the potential cause because of the patients having taken prednisolone for a long time. Furthermore, feces passing through the transvers colostomy and flowing into the stenosed descending colon caused increasing pressure in the descending colon and this perforation. It was a very rare case of the perforation in the colon located between two stomas.