Al-Balas Hamzeh, Al-Balas Mahmoud, Al-Wiswasy Mohammad
Department of General and Special Surgery, Faculty of Medicine, Hashemite University, Jordan.
Department of Surgery, Prince Hamza Hospital, Amman, Jordan.
Ann Med Surg (Lond). 2020 Nov 21;60:518-521. doi: 10.1016/j.amsu.2020.11.047. eCollection 2020 Dec.
Spontaneous perforation of the colon (SPC) is a rare disease characterized by sudden perforation of a clinically healthy colon in the absence of underlying disease or trauma. The aim of reporting this case is to highlight this surgical emergency in terms of clinical presentations, surgical management and outcomes.
A 68 year-old male with history of diabetes mellitus, hypertension and chronic constipation on daily laxatives presented to the emergency department with a diffuse abdominal pain and distention for 4 days associated with vomiting and absence of defecation where he was prescribed phosphate rectal enemas. Patient was in sepsis with generalized abdominal tenderness and distention. Intraoperative findings of feculent peritonitis with isolated cecal perforation was identified, for which a right hemicolectomy with end ileostomy was performed.
The first case was described in a woman presented with spontaneous rectum rupture by Brodie in 1827, with a less than 100 cases being reported in literature. In 1984, spontaneous perforations were classified into either "stercoral" or "idiopathic" perforations. More than 60% of colonic perforations were reported in the sigmoid or at the recto-sigmoid junction, mainly at the anti-mesenteric border, making spontaneous cecal perforation a very uncommon condition. Cecal perforation is associated with high mortality in the range of 30%-72%.
The outcome of SPC depends on multiple factors like onset of perforation, peritoneal contamination, and time of intervention. Regardless the surgical technique, early detection and surgical management are the main strategies associated with improving the outcomes.
结肠自发性穿孔（SPC）是一种罕见疾病，其特征为临床健康的结肠在无潜在疾病或创伤的情况下突然穿孔。报告该病例的目的是在临床表现、手术治疗及预后方面突出这种外科急症。
一名68岁男性，有糖尿病、高血压病史，因慢性便秘每日服用泻药，因弥漫性腹痛、腹胀4天，伴有呕吐及无排便而就诊于急诊科，在急诊科接受了磷酸直肠灌肠治疗。患者处于脓毒症状态，全腹压痛、腹胀。术中发现粪性腹膜炎伴孤立性盲肠穿孔，遂行右半结肠切除术加末端回肠造口术。
首例病例由布罗迪于1827年描述，为一名出现自发性直肠破裂的女性，文献报道的病例不足100例。1984年，自发性穿孔被分为“粪性”或“特发性”穿孔。超过60%的结肠穿孔发生在乙状结肠或直肠乙状结肠交界处，主要位于系膜对侧缘，因此自发性盲肠穿孔是一种非常罕见的情况。盲肠穿孔的死亡率较高，在30%-72%之间。
SPC的预后取决于穿孔的发生、腹腔污染及干预时间等多种因素。无论采用何种手术技术，早期发现及手术治疗是改善预后的主要策略。
