A CASE OF PERFORATION ON THE COLON CLOSE TO AN ARTIFICIAL ANUS PROBABLY CAUSED BY COLOSTOMY IRRIGATION

Abstract

We present a rare case of perforation of the colon close to an artificial anus probably caused by colostoy irrigation with a review of the literaturs. A 37-year-old man undergoing an operation for a sigmoid colon cancer 6 years before had been controlling his artificial anus by himself by colostomy irrigation for 4 months. He was aware of a mild pain around the artificial anus after irrigation for the last one month. As the pain increased, he was admitted to the hospital. Tenderness and the symptom of peritoneal irritation were observed around the artificial anus. No free air was found by a simple X-ray film and CT scan, but the intraperitoneal leak of contrast medium was found in the adoral site of the artificial anus. He was diagnosed to have peritonitis due to perforation of colon close to artificial anus. Resection of the adanal colon including the perforated site and reconstruction of artificial anus were performed. The perforated site was located at about 7cm oral from the opening of the artificial anus. Histological examination revealed the tear of muscularis propria in the periphery of the perforated site. The site which had become less resistant to the load was probably perforated by the mechanical factor at the time of colostomy irrigation. It is suggested that attention should always be paid to the risk of colonic perforation as a complication of colostomy irrigation.