IDIOPATHIC PERFORATION OF THE SIGMOID COLON WITH A LARGE DEFECT OF MUSCULAR LAYER

Abstract

A 29-year-old man was admitted to another hospital because of lower abdominal pain and anal pair that started suddenly a day before and was referred to the hospital for the progressing pain. Physical examination showed tenderness and muscular rigidity on the lower part of the abdomen and laboratory studies showed a little inflammatory change. There was no previous history of trauma or disease. Chest and abdominal plain X-ray film showed no free air below the diaphragm or intestinal gas, however abdominal CT scan revealed the extraluminal gas around the Sigmoid colon. With a diagnosis of peritonitis due to perforration of the bowel, the patient underwent on emergentcy laparotomy. There wat a thin part in the bowel wall of Sigmoid colon, 3×4cm in diameter, which had several perforations Histologic examination of the perforation's margin showed that the menbrane was sharply cut off without indentation and muscular layer was aparted by the depression of subserosal fat tissue and there were some inflammatory cell infiltrations without necrosis, granulation, nor microabscess. The hist-logical diagnosis was identical to the category of idiopathic perforation of the colon. This case is considered rare in that the perforation come about after the laceration of muscular layer because the size of perforation was smaller than that of the laceration of muscular layer.