Abstract
We report herein a case of stercoral perforation of the sigmoid colon, presenting a re-attack during treatment of hemodialysis for chronic renal failure, and adding a discussion of 60 cases documented in the Japanese literature. A 76-year-old female, who had had an episode of stercoral perforation of the sigmoid colon and had undergone Hartmann's procedure about 3 years previously, had sudden abdominal pain and was readmitted to our hospital. Abdominal X ray and CT findings showed free air and the colon impacted with a large number of scybala. Laparotomy revealed a perforation of the sigmoid colon, and scybala were seen in the abdominal cavity near the perforation and inside the total colon. Hartmann's procedure was performed, and she was discharged on postoperative day 18, uneventfully. In addition to the pressure of scybala on the colon wall, tight adhesion to colon mucosa of fecal mass, and a decrease of mucinous secretion from colon mucosa, are conceivable causes of a continuous local disturbance of blood flow of the colon wall. This mechanism might induce stercoral perforation of the colon.
