A CASE OF ISCHEMIC SIGMOID PERFORATION CAUSED BY GIANT BARIUM STERCOROMA

Abstract

Recently, we encountered a case of ischemic sigmoid perforation caused by a giant residual barium stercoroma following imaging of the upper digestive tract. The patient, a 68-year-old woman, reported to our hospital with a chief complaint of pain in the lower abdomen. At admission, marked tenderness, muscular guarding of the abdomen and Blumberg's sign were noted. Hematological tests revealed a reduction in leukocyte count and an abnormal rise in the CRP level. Plain radiography and CT of the abdomen exhibited a large amount of residual barium and the presence of free air under the diaphragm. A diagnosis of panperitonitis caused by gastrointestinal perforation and septic shock was given and the patient was subjected to emergency surgery. Laparotomy revealed a perforation where the sigmoid mesentery was attached, probably due to compression necrosis by a giant barium stercoroma, for which partial resection of the sigmoid and a colostomy were conducted. The postoperative course was satisfactory and the patient was discharged on December 20, 2000. Ischemic sigmoid perforation caused by comp ression necrosis due to a giant barium stercoroma is very unusual. The case was introduced and the literature was reviewed.