A Case of Simple Ulcer of the Sigmoid Colon with Recurrent Perforation

Toshihiko Waku, Yutaka Okada and Wataru Osawa

Department of Surgery, Ohara National Health Insurance Hospital

A 46-year-old man with a history of four episodes of perforation of the sigmoid colon during the previous 20 years was admitted to our hospital because of abdominal pain. Emergency operation with a preoperative diagnosis of intestinal perforation was performed. The resected specimen revealed punched-out perforation, and histological examination of the site of the perforation revealed only non-specific inflammation. Both the macroscopic and histological findings in this case were similar to those of the specimens obtained at the 2nd, 3rd, and 4th operations. We made the diagnosis of simple ulcer of the sigmoid colon based on the following findings: (1) the 1st punched-out perforation occurred at the age of 26 years; (2) the patient had never been constipated; (3) recurrent punched-out perforation occurred 5 times near the anastomotic site in the sigmoid colon in the absence of a diverticulum; (4) no granuloma formation was observed histologically; (5) no signs of Behet's disease were observed; and (6) colonfiberscopic examination revealed an ulcer scar near the anastomotic site 10 months after the 5th operation. Although the incidence of postoperative recurrence is high, simple ulcers may heal naturally, and medical therapy for early lesions, such as small and shallow ulcers, is effective. Since it is possible for simple ulcers which have never been treated by some therapy to cause recurrent perforations, we have to emphasize the importance of detecting early lesions and treating them at the early stage of recurrence.

Key words
simple ulcer of the sigmoid colon, perforation

Reprint requests
Toshihiko Waku Department of Surgery, Ohara National Health Insurance Hospital 39-2 Nakamachi, Ohara-cho, Aida-gun, Okayama, 707-0413 JAPAN

Accepted
November 13, 1998

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