Cecal Perforation Research Articles

Colonic ileus. An atypical form of adynamic ileus.

Colonic ileus is an atypical form of adynamic ileus that may closely simulate mechanical obstruction or vascular impairment of the colon on abdominal roentgenograms. Five cases occurred in association with pelvic surgery, electrolyte imbalance, lumbar spine trauma, acute appendicitis, and acute pancreatitis. No unifying concept as to cause or definite conclusion as to pathogenesis could be formulated. As with colonic obstruction, spontaneous cecal perforations may occur with colonic ileus. (JAMA230:1008-1009, 1974)

Adynamic ileus of the colon. An indication for cecostomy.

Twenty patients were seen with adynamic ileus of the colon, a condition characterized by massive gaseous distention of the large intestine in the absence of organic bowel obstruction. All except one patient had an associated major system disorder or operation that did not directly involve the gastrointestinal tract. Prominent abdominal distention was the prevailing clinical feature, and most patients also had signs and symptoms suggestive of mechanical obstruction of the large intestine. Diagnosis was generally made on the basis of the plain roentgenogram of the abdomen showing a marked and characteristically segmental dilation of the colon with a barium enema showing no obstructing lesion. There were three in-hospital deaths among the six patients managed nonoperatively, and three postoperative deaths among the 14 patients treated with a cecostomy. The one patient who developed a cecal perforation recovered following operation. Cecostomy is indicated when there is failure to improve within 72 hours or a cecal diameter greater than 12 cm.

Perforation of the colon associated with adynamic ileus

Cecal perforation is an uncommon complication of severe or prolonged adynamic ileus. Twelve instances have been collected from the literature and four additional patients are described. The mortality in this group of patients was 46 per cent. Early cecostomy prior to perforation is recommended.

Colon perforation in amebiasis.

Eight cases of colon perforation due to amebiasis, proved pathologically and surgically in the National Taiwan University Hospital, occurred during a ten-year period from 1959 to 1969. Colon perforation was found in 6% of the hospitalized patients with amebiasis. Because of the variability of the clinical picture, accurate diagnosis was commonly delayed. The sites of perforations were most frequently found at cecum, ascending colon, and sigmoid colon. Multiple perforations were noted in six out of eight cases. Surgical procedures used in this series included drainage, proximal enterostomy, exteriorization of the perforated colon, and segmental resection followed by exteriorization of both ends. All except patient 2 died. In case 2, direct exteriorization of the perforated cecum was performed with a complete cure.

Cecal perforation due to adynamic ileus.

Three cases of cecal perforation due to adynamic ileus are described—one following fracture of the right femur and two following elective surgical procedures consisting of routine herniorrhaphy and transthoracic vagotomy. The mechanism of perforation is though to be ischemia and gangrene on the antemesenteric border of the cecum, due to stretching and narrowing of the nutrient vessels during distention. Cecostomy and decompression are the treatment recommended.

Hirschsprung's disease in the neonate presenting as cecal perforation : O. O. A. Ajayi, T. F. Solanke, O. Seriki, and S. P. Bohrer. Pediatrics 43:102–106 (January), 1969

Hirschsprung's disease in the neonate presenting as cecal perforation : O. O. A. Ajayi, T. F. Solanke, O. Seriki, and S. P. Bohrer. Pediatrics 43:102–106 (January), 1969

Hirschsprung's Disease in the Neonate Presenting as Cecal Perforation

Two cases of cecal perforation in neonates due to Hirscbsprung's disease are presented. The clinical features in the two cases were increasing abdominal distension due to dilated bowel and pneumoperitoneum. The diagnosis was missed in the first case and, as a result, the infant was treated by simple closure of the perforation. A correct diagnosis was made in the second case and treatment was by closure of perforations and a transverse colostomy. The diagnosis may be suspected pre-operatively and should be suspected at surgery if a colonic perforation is discovered without any apparent cause. Biopsy of the rectum at the time of the laparotomy is suggested in order to avoid a second anesthetic prior to definitive operative treatment.

Free bowel perforations with regional enteritis.

ONE OF the long-recognized hallmarks of regional enteritis has been the frequency with which fistulae form between involved sections of bowel and contiguous structures. It is only recently that Robinson and Craft1and Waye and Lithgow2have brought to light the paucity of reported cases of free perforation in patients with regional enteritis. As Crohn himself stated in 1957, Free perforation of ileitis into the peritoneal cavity never occurs, or at least I have not seen it.3 To date there have been 31 cases of free perforation reported. Of these, 27 occurred in terminal ileum, 3 occurred in jejunum, and 1 occurred in a Meckel's diverticulum.4Only four of the 31 patients had a history and previous findings compatible with chronic regional enteritis.1,2,5,6 The case presented herein is particularly unusual in that the patient is the first reported to have a free cecal perforation

Complete sigmoidal obstruction following cesarean section

Complete sigmoidal obstruction is a rare complication of cesarean section. The diagnosis is readily made clinically and substantiated by roentgenologic studies. Early in the process nonsurgical treatment may be effective. Late in its course, surgical decompression by colostomy or cecostomy is imperative to prevent cecal perforation, which is associated with a very high mortality. Organic disease of the descending colon, sigmoid or rectum must be ruled out before closing the colostomy or cecostomy.

The mechanical factor in obstructive cecal perforation.

The inherent dangers of a closed-loop obstruction occurring in the large bowel are well known. The competency of the ileocecal valve is the single most important factor in the train of events that will occur subsequent to an obstructing colonic lesion. At the beginning of the 17th century, Bauhin described a sphincter between the cecum and the term nal ileum. He postulated that it acted mechanically to resist back-pressure. The presence of both circular and oblique muscle fibers indicates that the valve acts also as a true sphincter. In large-bowel obstruction, vomiting may occur late or not at all. With a competent ileocecal valve, a closed-loop obstruction results and the situation becomes most acute. The systemic symptoms may be misleading, and intestinal intubation will not alleviate the situation. The major danger is a mechanical perforation of the bowel, usually at the cecum; and because of this the condition requires immediate

Perforation of the cecum from obstructing carcinoma of the distal colon

1. 1. The literature is reviewed and shows that these cases are relatively uncommon but that the mortality is extremely high. 2. 2. The pathogenesis, clinical features, diagnosis, and treatment are discussed. 3. 3. Early diagnosis of carcinoma of the colon and proper treatment of acute obstruction of the colon is important in preventing the complication of cecal perforation with its attendant high mortality. 4. 4. The need for awareness of the possibility or imminence of perforation and indications for immediate decompression of the distended colon are emphasized.

Impending cecal perforation secondary to a crushing injury of the pelvis.

The purpose of this article is to report a case of adynamic ileus of such severity that the alarming distention of the cecum induced us to perform a cecostomy. The operative findings, substantiated by the final pathologic report, would indicate that, without surgical intervention, perforation of the cecum, with its alarming high mortality, would assuredly have occurred. Roentgenographic studies relating the greatest cecal diameter to impending cecal perforation pertain to ileus secondary to obstructing lesions of the colon distal to the cecum. In the cases reviewed by Davis and Lowman, 9 cm. is cited as the critical dimension beyond which cecal perforation was liable to occur. Eckman, Wenzke, and Abramson have recently reported a case of adynamic ileus in an elderly woman resulting in cecal perforation and her death. The greatest cecal diameter in their case was 9 cm. Their review of the recent literature indicated no other case reports

Roentgen criteria of impending perforation of the cecum.

IT IS THE PURPOSE of this paper to develop the concept of impending perforation of the cecum as a diagnostic entity which can be established simply and accurately by routine roentgen examination of the abdomen. It is important to be forewarned of the imminence of cecal perforation since, once this has occurred, the mortality rate of 70 per cent is unaffected by direct therapeutic effort (1, 15). The clinical signs and symptoms of impending perforation of the cecum (3, 10, 11, 13) are listed in Table 1. Because of their variability, these do not furnish a reliable basis for diagnosis. The roentgen evaluation of cecal size, on the other hand, provides a means of anticipating this emergency in large bowel obstruction. Beyond a critical point of size, perforation is imminent, whatever else may be suggested by the history, physical examination, or laboratory findings. Material Nineteen cases of cecal distention with distal large bowel obstruction, collected over a ten-year period, were studied roentgenographically, and the findings confirmed at surgery or postmortem. Comparative findings were obtained from a review of 79 cases described in the literature as diastatic perforation of the cecum. A control group was provided by experimental evaluation in 100 patients of the limits to which the cecum could be distended artificially. The range of cecal size in this control group was compared with that in the 19 patients in whom large bowel obstruction was the etiologic factor. Morbidity; Mortality; Criteria Neither the agent nor the site of the large bowel obstruction is related to the subsequent course of cecal distention. In the series reported here, the number of patients with impending perforation was almost twice the number with complete perforation: 12 to 7 (Tables II and III). Among the 79 cases from the literature (8, 11, 14), on the other hand, there was a striking preponderance of complete perforation- 13 cases to 1 of impending perforation. This difference may be attributed to early roentgen diagnosis in our series. The previously reported cases were diagnosed chiefly at autopsy. The immediate hospital mortality is intimately related to the integrity of the mucosa. The prognosis is best with the mucosa intact, becoming almost hopeless with mucosal disruption. There were 5 deaths among our 7 cases of complete perforation and 1 among the 12 patients in whom perforation had been considered imminent at the time of surgery. Since therapeutic measures were practically identical in the two groups, the possibility that different modes of treatment were responsible for the difference in immediate mortality can be discounted (Tables II and III). The upper limit of cecal size was determined, as mentioned above, by artificial distention of the cecum with barium and air in 100 selected patients without intrinsic cecal disease or distal large bowel 0 bstruction.

Perforation of the Cecum^;

Perforation of the Cecum^;

Perforation of the cecum.

Perforation of the cecum.

Esophagocecal Fistula Diagnosed Roentgenologically

The fact that a careful search of the medical literature failed to disclose any analogous case either diagnosed clinically or demonstrated roentgenologically seems to justify the publication of the following report. B. G., white female, 45 years old; esophageal stricture from swallowing lye; apparently successful attempts to dilate stricture not followed by general improvement, severe malnutrition; flushing of bowels shortly after feeding; lower right quadrant pain; roentgen demonstration of fistulous tract between perforation of esophagus and cecum; death from peritonitis following gastrostomy; postmortem examination. A 45-year-old housewife was admitted March 4, 1943, on the medical service of the Colorado General Hospital, complaining of loss of weight and strength and inability to retain food. The pre-admission diagnosis was severe malnutrition due to esophageal stricture. In October 1941, the patient had accidentally swallowed lye, vomiting one hour later. The next day she went to her local physician, who sent her to a hospital, where she stayed two weeks. She had since been more or less continuously under the care of a competent otolaryngologist, who had been attempting to dilate the developing stricture of the esophagus. In spite of an apparently successful dilatation, the patient, to the surprise of her doctor, continued to lose weight. This observation prompted him to send her to the Colorado General Hospital for thorough study. Some weeks before admission she began to experience discomfort in the right lower quadrant of the abdomen and pain in the right loin, both of which were aggravated by walking and by the erect posture. She therefore walked with a distinct limp, stooping a little forward and to the right and favoring the right side. The patient stated that she did not always regurgitate her food, which had been invariably in liquid form, and she was sure that sometimes it went into her stomach. On infrequent occasions, about twenty minutes after the meal had been apparently successfully taken, she would notice a great activity of the intestinal tract, in her own words “a boiling in her bowels.” Within another twenty minutes to half an hour she would have several very loose stools resembling in appearance the liquid meal just consumed. The patient's eyes, ears, mouth, and throat all appeared normal. It is interesting that the usual eye signs and mouth signs of vitamin deficiencies were absent. The tongue was coated, but not smooth, or red, or sore. The lungs were clear (physical examination). The blood pressure was 175/95. The rhythm of the heart was normal and no murmurs were present. The abdominal muscles were rigid, making examination difficult. This rigidity was more marked on the right side, but no obviously tender areas or masses were felt. The spleen and the liver were not palpable; findings on rectal and vaginal examination were normal. At the time of admission, urinalysis was as follows: specific gravity, 1.020; albumin, trace; no sugar; acetone, 4 plus; otherwise negative.

Perforation of Cecum by Foreign Bodies

Perforation of Cecum by Foreign Bodies