Fact-sheet: Colonic perforation
Updated on 06/29/2020 at 11:07 AM
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Definition
Disruptions of the digestive wall creating communication between the digestive lumen and the peritoneal cavity or the retroperitoneal and pararetroperitoneal spaces.
Clinical features
Severe abdominal pain, sometimes described as "stabbing." The pain, initially localized, rapidly becomes generalized and is exacerbated by vomiting, which occurs early and is copious.
Abdominal wall rigidity
Changes in bowel transit (subocclusion) occur later
Laboratory findings
Biological inflammatory syndrome, with elevated CRP, neutrophil count, and other inflammatory markers.
CT
Signs of diverticulitis with wall thickening of the colon, most often the sigmoid colon, along with infiltration of the pericolic fat and diverticula.
Signs of perforation: extraluminal gas localized within the mesosigmoid or at a distance in the pelvis, or free subdiaphragmatic pneumoperitoneum.
Management
– Stage I (colonic phlegmon or abscess): in case of failure of medical treatment and/or image-guided drainage, the recommended surgical treatment is resection with anastomosis
– Stage II: drain abscesses larger than 5 cm in greatest diameter under image guidance.
If drainage of the abscess is effective, delayed sigmoid resection is recommended, with anastomosis performed in the same procedure. If drainage fails or cannot be performed, surgical treatment is recommended, with anastomosis with or without a diverting stoma
– Stage III (generalized purulent peritonitis): sigmoid resection.
– Stage IV (fecal peritonitis): the Hartmann procedure is the reference intervention.
Classification
Hinchey classification:
- stage I: pericolic phlegmon or abscess
– stage II: pericolic phlegmon or abscess with pelvic, retroperitoneal, or distant abdominal abscesses
– stage III: generalized purulent peritonitis
– stage IV with fecal peritonitis