Hardy T G, Hartmann R F, Aguilar P S, Stewart W R
Dis Colon Rectum. 1983 Feb;26(2):116-8. doi: 10.1007/BF02562589.
Four of five patients survived perforation of the colon incidental to barium-enema examination, while the other survived without sequela of infection until hemiplegia and pneumonia supervened two and 36 days, respectively, postoperatively. It is postulated that adequate intravenous fluids, early operation, with complete cleansing by antibiotic irrigation and mechanical debridement of the abdominal cavity, along with excision of the perforated segment of bowel with establishment of an end colostomy or ileostomy and distal mucous fistula, if possible, are keys to survival in these patients. Triple antibiotics, using ampicillin, gentamicin, and clindamycin, or metronidazole, should be administered in all patients as soon as the diagnosis is made, and continued postoperatively as indicated until there is no evidence of infection. An intraluminal intestinal tube, for stichless plication of the small bowel, may be helpful in some patients. A stomacone should be used for a barium enema through a colostomy stoma. Care should be exercised in performing barium contrast studies in patients with inflammatory bowel disease.
五名患者中有四名在钡剂灌肠检查时并发结肠穿孔后存活，另一名患者术后分别在第2天和第36天出现偏瘫和肺炎之前，未发生感染后遗症而存活。据推测，充足的静脉补液、早期手术、通过抗生素灌洗和机械清创彻底清洁腹腔、切除穿孔肠段并尽可能建立结肠造口术或回肠造口术以及远端黏液瘘，是这些患者存活的关键。一旦确诊，所有患者都应立即使用氨苄西林、庆大霉素和克林霉素或甲硝唑联合使用的三联抗生素，并根据需要在术后持续使用，直至没有感染迹象。对于一些患者，用于小肠无缝缝合的腔内肠管可能会有所帮助。应使用造口圆锥体通过结肠造口进行钡剂灌肠。对患有炎症性肠病的患者进行钡剂造影检查时应谨慎操作。
