A CASE OF IDIOPATHIC PERFORATION OF THE TRANSVERSE COLON

Abstract

A case of idiopathic perforation of the transverse colon is reported. A 79-year-old woman was referred to the hospital because of abdominal pain after taking a purgative medicine for constipation. On admission, there were severe tenderness in the upper abdominal region and signs of peritoneal irritation. Intraperitoneal free air was detected by abdominal X-ray film and computed tomography. Emergency operation was carried out under a diagnosis of perforating pertitonitis. Laparotomy findings revealed a punched out perforation 2 cm in size in the anterior wall of the transverse colon, and fecal materials in the omental bursa. After irrigation of peritoneal cavity with massive isotonic solution, a partial resection of the transverse colon including perforated portion was performed. Histologically no regenerative mucosa was seen around the perforated area, but sharp break off muscle layer, and neutrophil cell infiltration in the subserosal tissue were demonstrated. After the operation she was managed under artificial respirator assisted ventiration until 16 th postoperative day (POD) because of septic shock state, and discharged 84 th POD. On the occasion of an aged person's sudden abdominal pain, early diagnosis and early therapy should be performed bearing a possibility of idiopathic perforation of the colon in mind.