[Sigmoid colon perforation with local peritonitis caused by indirect trauma--case report and review of the literature].
Injuries to the sigmoid occur either as acute or protracted events. In the first case, enteral contents discharge into the abdominal cavity and a generalized, fecal, life-threatening peritonitis with a bad prognosis develops. In the protracted form, the rupture is covered by peritoneum and adherent organs before perforation. The ensuing abscess formation may lead to perforation into contiguous visceral organs or the cutis. Frequently an intestinal or cutaneous fistula results. The trigger for a sigmoid perforation can be a spontaneous rupture in an already vulnerable intestine. Common precursory diseases are diverticulitis, colitis, carcinomas, and necroses. Also, elevated intestinal pressure invoked by increased bearing down or coproliths may cause disruption. Diagnostic procedures such as rectoscopy and rectal contrast instillation are frequent idiopathic causes of traumatic injuries to the sigmoid. Perforating injuries of the abdominal cavity by stabbing, gunshot, or impalement may affect the sigmoid and open its lumen. Foreign bodies often lead to traumatic injuries of the rectosigmoid junction. In contrast, indirect trauma as a cause of sigmoid perforation, which is described in the following case, is very rare. A 62-year-old woman,who had a cholecystectomy and adhesive strangulation of intestine in her history, was admitted to our clinic after falling down stairs and landing on her bottom. She suffered a sigmoid rupture and peritonitis. Laparotomy and suturing of the sigmoid defect were performed.
Berufsgenossenschaftliche Kliniken Bergmannsheil, Chirurgische Klinik und Poliklinik, Universitätsklinik, Bochum.
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Andereya
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Kälicke
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D000058:Accidental Falls; D012809:Colon, Sigmoid / Q000293:injuries* / Q000601:surgery; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D008875:Middle Aged; D010538:Peritonitis / Q000175:diagnosis / Q000601:surgery*; D012421:Rupture; D014949:Wounds, Nonpenetrating / Q000175:diagnosis / Q000601:surgery*