A series of 44 cases of perforation of the large intestine which were operated on at the hospital in a recent 12-year period were studied. There were 23 men and 21 women with a mean age of 69 years old. Abdominal pain was the common complaint seen in the all patients, and otherwise bloating, nausea and vomiting were observed. As to abdominal findings, tenderness was noted in almost all patients and Blumberg signs and muscular defense were seen in 36 patients. The mean time from the onset of the disease to admission was 39 hours, and the mean duration of hospital stay was 62.1 days. Patients in shock state preoperatively or with decreased total protein had poor prognosis. Intraabdominal free air occurred in 26 patients that represented 59.1% of all patients. The most common site of perforation was the sigmoid colon (30 cases), followed by the rectum, cecum, and transverse colon, in this order. Causative diseases included iatrogenic in 17 cases, diverticulitis in 11 cases, colorectal cancer, and idiopatic diseases. There were five deaths. All five patients died of septecemia and multi-organ failure. Our recent attempt of endotoxin adsorption due to blood filtration for septicemia successfully saved a patient.
Nihon Rinsho Geka Gakkai Zasshi (Journal of Japan Surgical Association)