A Patient who Experienced Two Idiopathic Perforations of the Colon Within Five Months

Abstract

A 68-year-old woman with rheumatoid arthritis, being treated with prednisolone (7.5 mg/day) and methotrexate (4mg/week), was suspected to have a perforation of the colon based on abdominal computed tomography. She underwent resection of the perforated part of the transverse colon and colostomy. Postoperatively, she developed septic shock requiring a multidisciplinary treatment regimen including continuous hemodiafiltration. Her symptoms resolved, and she was discharged on day 26. She complained of abdominal pain again 125 days after discharge, and imaging showed air in the mesenterium near the stoma. There was a perforation measuring 2.5 cm at the oral side of the transverse colon stoma which had been created during the initial treatment. She underwent right hemicolectomy and ileostomy. The postoperative course was favorable, and she was discharged on day 18. Both lesions were diagnosed as idiopathic perforation of the colon based on neither of the pathological specimens showing any evidence of vasculitis or ulceration. To our knowledge, only 5 cases with multiple idiopathic perforations of the colon have been reported in Japan. Clinicians should be aware of the possibility of perforation recurrence.