Stercoral Perforation of the Sigmoid Colon Presenting with Mediastinal, Retroperitonial, Sigmoid Mesenterial and Massive Subcutaneous Emphysema: Report of a Case

Tetsuya Kanehiro¹⁾, Yoshio Yuasa²⁾, Hiroyuki Nobuhara²⁾, Takeshi Sudo³⁾, Arata Kamimatsuse³⁾, Hiroaki Tsumura¹⁾, Yoshiaki Murakami³⁾ and Taijiro Sueda³⁾

Department of Surgery, Hiroshima Municipal Hunairi Hospital¹⁾
Department of Surgery, Itsukaichi Memorial Hospital²⁾
Department of Surgery, Division of Clinical Medical Science, Graduate School of Biomedical Science, Horoshima University³⁾

We report an extremely rare case of stercoral perforation of the sigmoid colon presenting as subcutaneous emphysema on admission. A 87-year-old man with a history of cerebral infarction and ongoing severe constipation suddenly vomited. In November 13, 2002, he was referred for reduced consciousness and hypotension the next day. Leukopenia, and hepatic and renal dysfunction were confirmed. Computed tomography of the abdomen showed free gas in the abdominal cavity, and emphysema was apparent from the sigmoid mesentery to the retroperitonium and mediastinum, with extensive subcutaneous emphysema in the left abdominal and thoracic and cervical regions. Based on these findings, we conducted emergency surgery under a diagnosis of diffuse peritonitis caused by perforation of the digestive tract. A large volume of contaminated ascites was found in the abdominal cavity and the descending colon, sigmoid colon, and rectum were markedly dilated. The perforation was located at the dilated sigmoid colon on the medial and dorsal border. The sigmoid mesentery was emphysematous, and a large quantity of caddy stool had leaked into the abdominal cavity. Hartmann's procedure, peritoneal lavage, and drainage were done. Pathological testing of excised tissue showed no diverticuli in the perforated area and, although the stool was not hard, the wall of the sigmoid colon had become necrotic due to severe constipation and the subsequent increase in intestinal pressure.

Key words
stercoral perforation, emphysema

Reprint requests
Tetsuya Kanehiro Department of Surgery, Hiroshima Municipal Funairi Hospital
14-11 Funairisaiwai-cho, Naka-ku, Hiroshima, 730-0844 JAPAN

Accepted
January 26, 2005

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