Abstract
We report an extremely rare case of stercoral perforation of the sigmoid colon presenting as subcutaneous emphysema on admission. A 87-year-old man with a history of cerebral infarction and ongoing severe consti-pation suddenly vomited. In November 13, 2002, he was referred for reduced consciousness and hypotension the next day. Leukopenia, and hepatic and renal dysfunction were confirmed. Computed tomography of the abdomen showed free gas in the abdominal cavity, and emphysema was apparent from the sigmoid mesen-tery to the retroperitonium and mediastinum, with extensive subcutaneous emphysema in the left abdominal and thoracic and cervical regions. Based on these findings, we conducted emergency surgery under a diagno-sis of diffuse peritonitis caused by perforation of the digestive tract. A large volume of contaminated ascites was found in the abdominal cavity and the descending colon, sigmoid colon, and rectum were markedly di-lated. The perforation was located at the dilated sigmoid colon on the medial and dorsal border. The sigmoid mesentery was emphysematous, and a large quantity of caddy stool had leaked into the abdominal cavity. Hartmann's procedure, peritoneal lavage, and drainage were done. Pathological testing of excised tissue showed no diverticuli in the perforated area and, although the stool was not hard, the wall of the sigmoid colon had become necrotic due to severe constipation and the subsequent increase in intestinal pressure.
