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慢性便秘导致乙状结肠直肠部粪性穿孔:一例报告

Stercoral perforation of the rectosigmoid colon due to chronic constipation: A case report.

作者信息

Celayir Mustafa Fevzi, Köksal Hakan Mustafa, Uludag Mehmet

机构信息

Sisli Hamidiye Etfal Research and Training Hospital, Department of General Surgery, Istanbul, Turkey.

Sisli Hamidiye Etfal Research and Training Hospital, Department of General Surgery, Istanbul, Turkey.

出版信息

Int J Surg Case Rep. 2017;40:39-42. doi: 10.1016/j.ijscr.2017.09.002. Epub 2017 Sep 14.

Abstract

INTRODUCTION

Chronic constipation is very common in elderly patients. As a result of this situation fecaloma is also frequently seen at these ages. However, the stercoral perforation caused by fecaloma is a rare situation to occur. The rectosigmoid colon is the most affected colonic segment. It is seen in older patients with concomitant diseases and a low quality of life.

PRESENTATION OF CASE

Here in this case, we have to report an 83 - year-old male patient who came to the emergency room with complaints of abdominal pain and constipation for two days. He had Type II Diabetes Mellitus, had a cardiac stent and also Alzheimer's disease. We diagnosed a rectosigmoid perforation due to a large fecaloma. This case presentation was prepared in accordance with the scare checklist guidelines (Agha et al., 2016 [1]).

DISCUSSION

Constipation and faecal impaction are common entities, particularly in elderly and bedridden patients. Fecalomas are collections of dehydrated, hardened stool. They rarely can cause colonic ischemia and/or stercoral perforation. Stercoral perforation is the perforation or rupture of the intestine walls by a stercoraceous mass. Stercoral perforation is a very dangerous, life-threatening situation, as well as a surgical emergency, because the spillage of contaminated intestinal contents into the abdominal cavity leads to peritonitis, a rapid bacteremia with many complications.

CONCLUSION

Fecalomas can cause stercoral perforations. This situation can be confused with other causes of acuteabdomen in these patients. Early surgery can be life saving.

摘要

引言

慢性便秘在老年患者中非常常见。由于这种情况,粪块瘤在这些年龄段也经常出现。然而,由粪块瘤引起的粪性穿孔是一种罕见的情况。直肠乙状结肠是受影响最严重的结肠段。它常见于患有合并症且生活质量较低的老年患者。

病例介绍

在此病例中,我们报告一名83岁男性患者,因腹痛和便秘两天前来急诊室。他患有II型糖尿病,有心脏支架,还患有阿尔茨海默病。我们诊断为巨大粪块瘤导致的直肠乙状结肠穿孔。本病例报告是根据SCare清单指南(Agha等人,2016 [1])编写的。

讨论

便秘和粪便嵌塞是常见情况,特别是在老年和卧床患者中。粪块瘤是脱水、硬结粪便的聚积物。它们很少会导致结肠缺血和/或粪性穿孔。粪性穿孔是指肠道壁被粪质团块穿孔或破裂。粪性穿孔是一种非常危险、危及生命的情况,也是一种外科急症,因为受污染的肠内容物溢入腹腔会导致腹膜炎、快速菌血症及许多并发症。

结论

粪块瘤可导致粪性穿孔。这种情况在这些患者中可能与其他急腹症原因相混淆。早期手术可能挽救生命。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/11b0/5607122/24638bab5960/gr1.jpg

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