A Case Report of Multiple Ulcers of Sigmoid Colon with a Perforation suspected being Induced by Aspirin

Koichi Hoshikawa, Toru Yoshida²⁾, Koichiro Sato²⁾, Taketo Kato²⁾, Shin Obara²⁾, Yoshiyuki Yashima²⁾, Takashi Sato¹⁾ and Go Wakabayashi

Department of Surgery and Department of Pathology II¹⁾, Iwate Medical University School of Medicine
Department of Surgery, Iwate prefectural Kamaishi Hospital²⁾

We report a rare case of colonic ulcers with perforation suspected being induced by aspirin. A 78-year-old woman admitted for episodic lower abdominal pain and vomiting. She was medicated with enteric-coated aspirin due to atrial fibrillation and mitral regurgitation. Her abdomen was rigid and bowel sounds scanty. She was afebrile and abdominal X-ray was normal. Abdominal computed tomography showed inflammation of the sigmoid descending colon and large amounts of ascites. Based on a diagnosis of panperitonitis due to lower intestinal perforation, we undertook surgical exploration. Laparotomy showed a large amount of turbid ascites and sigmoid colon ulcers with a 3 mm perforation, necessitating colectomy with colostomy. Microscopic examination showed multiple deep ulcers and nonspecific inflammation of the colon without evidence of Crohn's disease, vascular occlusion, or diverticulitis. The definitive diagnosis was thought to be colonic ulcers and perforation induced by nonsteroidal antiinflammatory drugs (NSAIDs). Recovery was uneventful. After closure of the colostomy, she was discharged in good condition.

Key words
aspirin, NSAIDs, colon perforation

Reprint requests
Koichi Hoshikawa Department of Surgery, Iwate Medical University School of Medicine
19-1 Uchimaru, Morioka, 020-8505 JAPAN

Accepted
December 19, 2007

To read the PDF file you will need Abobe Reader installed on your computer.