Abstract
BackgroundCarcinoma of the colon may present with perforation proximal to the site of malignancy. Caecum is the commonest site of perforation if the ileocecal valve is patent and the jejunal and ileal perforations are very rare.Case presentationA 35 year male presented with intestinal obstruction. Emergency laparotomy revealed carcinoma of the transverse colon with multiple pinpoint perforations along antimesenteric border of ileum, which were wrapped with omentum, and no peritoneal contamination was present. Extended right hemicolectomy with jejunocolic anastomosis was done. Patient made uneventful recovery in postoperative period and was treated with adjuvant chemotherapy.ConclusionPatients with colonic carcinoma and incompetent ileocecal valve may present with intestinal perforation. Increased intraluminal pressure and closed loop obstruction may lead to ischemia and perforation of the small bowel.
Highlights
Carcinoma of the colon may present with perforation proximal to the site of malignancy
Patients with colonic carcinoma and incompetent ileocecal valve may present with intestinal perforation
Increased intraluminal pressure and closed loop obstruction may lead to ischemia and perforation of the small bowel
Summary
It is very unusual to find a case of carcinoma colon with associated multiple perforations of proximal part. In 4 to 5% cases, presentation of carcinoma colon is with perforation. We hereby report a case of carcinoma of transverse colon presenting with acute intestinal obstruction. Laparotomy revealed carcinoma of transverse colon with dilated small bowel and multiple small pin point perforations along antimesenteric border wrapped up by omentum. A 35 year male presented with features of acute intestinal obstruction He was unable to pass faeces and flatus with pain in abdomen since last five days. X-ray of abdomen in erect posture revealed multiple air fluid level and dilated small bowel loops. Gross examination of the resected segment revealed ischemic ileum about 4 feet in length with multiple perforations along antimesenteric border (Figure 1).
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