Abstract
An 80-year-old man was seen at the hospital because of appetite loss 5 days after he had fallen down and got a bruise on the abdomen in his garden. Abdominal plain CT scan showed a soft-part shadow including air in an area outside the intestine and on the ventral aspect of the Morrison's pouch and the transverse colon. The patient was admitted to the hospital with a suspicion of intra-abdominal abscess formation secondary to minute perforation of the lower digestive tract. His clinical course was conservatively observed. Enema study disclosed transudation of contrast material from the intestine in the vicinity of the hepatic flexura of the colon and at the center part of the transverse colon. Thereafter oral ingestion was started after we confirmed that there was no transudation of contrast material from the intestine by barium enema. The patient was discharged very much improved on the 44th day after the trauma. He has been followed in the clinic, without signs of recurrence.
It is believed that lower gastrointestinal perforation can follow a fatal course in a high possibility and the patient is a candidate for emergency operation as a rule. However, there are some cases in which surgical intervention can be avoided by conservative therapy, and hence we must keep the fact in mind in the diagnosis of acute abdomen.
