A Case of Colonic Perforation That Was Conservatively Treated in a Patient with Vascular Ehlers-Danlos Syndrome

Abstract

A 24-year-old woman visited the emergency room at our hospital with a complaint of left abdominal pain. She had a history of bilateral internal carotid artery dissection and bilateral vertebral artery dissection and had been diagnosed with vascular Ehlers-Danlos syndrome (EDS) 8 months before. Abdominal CT at the time of her visit revealed intramural emphysema and free air at the splenic curve of the colon, which suggested colonic perforation. Given that abdominal pain was localized, making it unlikely to be due to peritonitis, and that there are high risks associated with surgery in patients with vascular EDS, we chose conservative treatment. After admission, the inflammatory reaction and abdominal symptom improved steadily, and she was discharged on the 29th hospital day. Although surgery is a basic treatment strategy for colonic perforation, a careful decision is required since delayed wound healing often causes serious postoperative complications. This case suggests that conservative treatment can be an option if symptoms are mild and the general condition is relatively good in patients who have been diagnosed with vascular EDS.