title: Transverse colon perforation due to carcinoma rectum: an unusual presentation against Laplace's law.
abstract: We present a case of distal large bowel obstruction, in the setting of a competent ileocaecal valve, the caecum is the most common site of perforation (for Laplace's law). We describe a case of obstruction at the rectum due to constricting carcinomatous growth, presenting with perforation of transverse colon (against Laplace's law). A 60-year-old women presented to the emergency department with acute abdominal pain. The pain was preceded by 3 days of intestinal obstruction. Clinically there was guarding and rigidity. Straight X-ray of the abdomen revealed free gas under diaphragm. Surgical exploration revealed transverse colon perforation with carcinoma of rectum. Loop transverse colostomy was performed as the patient was very sick. The patient improved slowly in the intensive care unit. To conclude, even though the caecum is the most common site for perforation in case of distal obstruction, perforation of transverse colon can occur otherwise as a unique presentation.
authors: Department of General Surgery, SCB Medical College, Cuttack, Odisha, India. manash67@gmail.com
authors: Manash Ranjan
authors: MR
authors: Sahoo
authors: Anil
authors: A
authors: Kumar
authors: Sunil
authors: S
authors: Jaiswal
authors: Basavaraja
authors: B
authors: C
mesh_terms: D002277:Carcinoma / Q000150:complications*; D044684:Colon, Transverse; D005260:Female; D006801:Humans; D007415:Intestinal Obstruction / Q000150:complications*; D007416:Intestinal Perforation / Q000209:etiology*; D008875:Middle Aged; D055585:Physical Phenomena; D012004:Rectal Neoplasms / Q000150:complications*; D012039:Regional Blood Flow
references: Dis Colon Rectum. 1986 Mar;29(3):203-10
references: 3753674
references: Neurogastroenterol Motil. 2005 Jun;17 Suppl 1:41-9
references: 15836454
references: Aust N Z J Surg. 1960 May;29:332-9
references: 14440306
references: Am J Proctol. 1963 Oct;14:309-14
references: 14071366
references: Am J Surg. 1961 Jan;101:26-31
references: 13761918
references: Radiology. 2003 Apr;227(1):52-8
references: 12601195
references: Chirurgie. 1974 May 15;100(7):502-16
references: 4430253
references: Br J Surg. 1975 May;62(5):383-6
references: 1139134
references: Dis Colon Rectum. 1973 Jul-Aug;16(4):305-11
references: 4720004
references: Am J Roentgenol Radium Ther Nucl Med. 1975 Feb;123(2):281-6
references: 1115305
references: Dis Colon Rectum. 1987 Jun;30(6):410-6
references: 3595357
references: Surg Gynecol Obstet. 1956 Dec;103(6):711-8
references: 13380697
references: Br J Surg. 1957 Nov;45(191):270-4
references: 13510694
references: AJR Am J Roentgenol. 1985 Dec;145(6):1211-7
references: 3877425
references: Dis Colon Rectum. 1967 Nov-Dec;10(6):415-20
references: 6066365
references: Dis Colon Rectum. 1998 Nov;41(11):1421-6
references: 9823810
references: Ann Surg. 1956 Feb;143(2):251-5
references: 13292879
references: Gastrointest Endosc. 2005 Jan;61(1):37-45
references: 15672054