Annals of Coloproctology

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Original Article

Benign GI diease

Prognostic Factors and Management for Left Colonic Perforation: Can Hartmann’s Procedure Be Preventable?: Yilseok Joo, Yujin Lee, Taeyoung Yoo, Jungbin Kim, Inseok Park, Geumhee Gwak, Hyunjin Cho, Keunho Yang, Kiwhan Kim, Byung-Noe Bae; Ann Coloproctol. 2020;36(3):178-185. Published online June 30, 2020; DOI: https://doi.org/10.3393/ac.2019.11.14.1

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Purpose
To identify factors significantly associated with the mortality of patients with left colonic perforation, and to compare the outcome of Hartmann’s procedure (HP) and primary repair (PR) or primary anastomosis (PA) in patients with left colonic perforation without factors associated with mortality.
Methods
This retrospective study included patients who underwent surgery for left colonic perforation from January 2009 to February 2018. Preoperative factors related to postoperative mortality, including vital signs, laboratory findings, and intraoperative findings, were analyzed by type of operation. The chi-square, Fisher exact, and Mann-Whitney U-tests were used to analyze the data.
Results
Ninety-one patients were included (36 men, 55 women), and 15 (16.5%) died postoperatively. Prognostic factors were age, leukopenia, thrombocytopenia, bleeding tendency, acute kidney injury, hemodynamic instability, and the existence of feculent ascites. Leukopenia and longer operative time were independent risk factors for mortality. Seventy-nine patients did not have leukopenia and 30 of these patients who underwent PR without diversion were excluded from the subanalysis. HP was performed in 30 patients, and PR with diversion and PA with or without diversion were performed in 19. Compared to the other operative methods, HP had no advantage in reducing hospital mortality (P=0.458) and morbidity.
Conclusion
Leukopenia could be an objective prognostic factor for left colonic perforation. Although HP is the gold standard for septic left colonic perforation, it did not improve the hospital mortality of the patients without leukopenia. For such patients, PR or PA may be suggested as an alternative option for left colonic perforation.

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Risk Factors for Postoperative Major Morbidity, Anastomotic Leakage, Re-Surgery and Mortality in Patients with Colonic Perforation
Maximilian Brunner, Lara Gärtner, Andreas Weiß, Klaus Weber, Axel Denz, Christian Krautz, Georg F. Weber, Robert Grützmann
Journal of Clinical Medicine.2024; 13(17): 5220. CrossRef
Evaluation of Morbidity and Mortality in Iatrogenic Colonic Perforation During Colonoscopy: A Comprehensive Systematic Review and Meta-Analysis
Ajibola A Adebisi, Daniel E Onobun, Adeola Adediran, Reginald N Ononye, Ethel O Ojo, Adedayo Oluyi, Ayotunde Ojo, Stephen Oputa
Cureus.2024;[Epub] CrossRef
Patient outcomes and prognostic factors associated with colonic perforation surgery: a retrospective study
Do-bin Lee, Seonhui Shin, Chun-Seok Yang
Journal of Yeungnam Medical Science.2022; 39(2): 133. CrossRef
Morbidity and Mortality of Neutropenic Patients in Visceral Surgery: A Narrative Review
Ann-Kathrin Lederer, Fabian Bartsch, Markus Moehler, Peter Gaßmann, Hauke Lang
Cells.2022; 11(20): 3314. CrossRef

Case Reports

Malignant disease, Benign GI diease,Colorectal cancer,Complication

An Unusual Case of Colon Perforation With Multiple Transmural Ulcers After Use of Polmacoxib and Everolimus in a Metastatic Breast Cancer Patient: In-Gyu Song, Kyung Uk Jung, Hyung Ook Kim, Hungdai Kim, Ho-Kyung Chun; Ann Coloproctol. 2021;37(2):120-124. Published online March 16, 2020; DOI: https://doi.org/10.3393/ac.2019.08.17

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Abstract PDF

Everolimus (Afinitor) is an inhibitor of mammalian target of rapamycin. Polmacoxib (Acelex) is a nonsteroidal anti-inflammatory drug that belongs to the cyclooxygenase-2 (COX-2) inhibitor family and is mainly used for treatment of arthritis. Intestinal perforation has not been reported previously as a complication of everolimus, and perforation of the lower intestinal tract caused by a selective COX-2 inhibitor is extremely rare. We present here a case of colon perforation that occurred after use of polmacoxib in a metastatic breast cancer patient who had been treated with everolimus for the preceding six months.

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Identification of Drugs Associated With Oral Ulcers Based on Pharmacovigilance
Xinyue Zhang, Xueqing Li, Wuda Huoshen, Shiting Li
International Dental Journal.2025; 75(6): 103957. CrossRef
Multiple ulcers and perforation of small intestine with everolimus use in a patient with rectal neuroendocrine tumor: A case report
Kentaro Abe, Shigenobu Emoto, Kazuhito Sasaki, Hiroaki Nozawa, Yoichi Yasunaga, Soichiro Ishihara
International Journal of Surgery Case Reports.2023; 106: 108094. CrossRef
Everolimus/polmacoxib

Reactions Weekly.2021; 1869(1): 157. CrossRef

Colonoscopic Removal of an Intrauterine Device That Had Perforated the Rectosigmoid Colon: Jin Myeong Huh, Ki Seok Kim, Yong Seok Cho, Dong Kwon Suh, Jae Uk Lee, Seong Deuk Baek, Sin Kil Moon; Ann Coloproctol. 2018;34(2):106-108. Published online April 30, 2018; DOI: https://doi.org/10.3393/ac.2017.10.30

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Abstract PDF

The intrauterine device (IUD) is a widely used contraceptive method. One of the most serious and rare complications of using an IUD is colon perforation. We report a case of colonoscopic removal of an IUD that had perforated into the rectosigmoid colon in a 42-year-old woman who presented with no symptoms. Colonoscopy showed that the IUD had penetrated into rectosigmoid colon wall and that an arm of the IUD was embedded in the colon wall. We were able to remove the IUD easily by using colonoscopy. The endoscopic approach may be considered the first choice therapy for selected patients.

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Migrated Foreign Body Perforating the Colon: Scope for Colonoscopy
Aparimita Das, Tarun S Joseph, Gangireddy Siva Sankar Reddy, Amrit Pipara, Sumit Mukhopadhyay
Cureus.2025;[Epub] CrossRef
Retroperitoneal Displacement of an Intrauterine Device (IUD): A Case Report
Godwin Silas Macheku, Fidelis Clarence Jungulu, Ezekiel Kalibugwe Kiyogoma, Kheri Kagya, Salehe Mrutu, Michael Johnson Mahande
International Journal of Innovative Science and Research Technology.2025; : 713. CrossRef
Rectal Foreign Body Shaped Like an Endoscopic Clip: Migrated Intrauterine Devices to the Rectum
Xinyu Xie, BoYuan, Chunmei Li, Lina Cao
Digestive Diseases and Sciences.2025; 70(9): 2899. CrossRef
Endoscopic Removal of Intrauterine Contraceptive Device From the Descending Colon: A Case Report
Muhammad Shabbir, Mishal A Aljohani, Abdurahman Alfaiz, Msab Aldakheel, Zeeshan Ali
Cureus.2024;[Epub] CrossRef
Colonoscopic removal of an intrauterine device with rectal perforation: A case report
Lingrun Ye, Yuanyuan Zhu, Fanglai Zhu
Medicine.2024; 103(28): e38872. CrossRef
Is It a “Colon Perforation”? A Case Report and Review of the Literature
Shuangshuang Lu, Xinyu Yao, Jun Shi, Jian Huang, Shaohua Zhuang, Junfang Ma, Yan Liu, Wei Zhang, Lifei Yu, Ping Zhu, Qiuwei Zhu, Ruxia Shi, Hong Zheng, Dong Shao, Yuyan Pan, Shizhen Bao, Li Qin, Lijie Huang, Wenjia Liu, Jin Huang
Frontiers in Medicine.2022;[Epub] CrossRef
Endoscopic removal of an intrauterine device from the lumen of the sigmoid colon
V. V. Bereshchenko, D. V. Lazarevich, N. N. Goncharov, P. V. Khodanovich
Health and Ecology Issues.2022; 19(1): 145. CrossRef
Incomplete Removal of an Intrauterine Device Perforating the Sigmoid Colon
Junseak Lee, Jung Hwan Oh, Jinsu Kim, Chul-Hyun Lim, Sung Hoon Jung
The Korean Journal of Gastroenterology.2021; 78(1): 48. CrossRef
Chronic nodules of sigmoid perforation caused by incarcerated intrauterine contraception device
Xiaohui Huang, Rui Zhong, Liqin Zeng, Xuhui He, Qingshan Deng, Xiuhong Peng, Jieming Li, Xiping Luo
Medicine.2019; 98(4): e14117. CrossRef
Endoscopic Removal of Migrated Intrauterine Device: Case Report and Review of Literature and Technique
Yang Lei, Vadim Iablakov, Riaz J. Karmali, Nauzer Forbes
ACG Case Reports Journal.2019; 6(6): e00090. CrossRef

Colorectal Perforation After Anorectal Manometry for Low Anterior Resection Syndrome: Kyung Ha Lee, Ji Yeon Kim, Young Hoon Sul; Ann Coloproctol. 2017;33(4):146-149. Published online August 31, 2017; DOI: https://doi.org/10.3393/ac.2017.33.4.146

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Abstract PDF

We experienced 3 cases of manometry-induced colon perforation. A 75-year-old man (case 1) underwent anorectal manometry (ARM) 3 years after radiotherapy for prostate cancer and a laparoscopic intersphincteric resection for rectal cancer. A 70-year-old man (case 2) underwent ARM 3 months after conventional neoadjuvant chemoradiotherapy and a laparoscopic low anterior resection for rectal cancer. A 78-year-old man (case 3) underwent ARM 2 months after a laparoscopic intersphincteric resection for rectal cancer. In all cases, a colon perforation with fecal peritonitis occurred. All were treated successfully using prompt and active operations and were discharged without any complications. ARM with a balloon, as a measure of rectal compliance, should be performed 2 months or longer after surgery. If a perforation occurs, prompt and active surgical intervention is necessary due to the high possibility of extensive fecal peritonitis.

Citations

Citations to this article as recorded by

Effect of low anterior resection syndrome on quality of life in colorectal cancer patients: A retrospective observational study
Dong-Ai Jin, Fang-Ping Gu, Tao-Li Meng, Xuan-Xuan Zhang
World Journal of Gastrointestinal Surgery.2023; 15(10): 2123. CrossRef
Functional anorectal studies in patients with low anterior resection syndrome
Ssu‐Chi Chen, Kaori Futaba, Wing Wa Leung, Cherry Wong, Tony Mak, Simon Ng, Hans Gregersen
Neurogastroenterology & Motility.2022;[Epub] CrossRef
Variation in rectoanal inhibitory reflex after laparoscopic intersphincteric resection for ultralow rectal cancer
Bin Zhang, Ke Zhao, Yu‐Juan Zhao, Shu‐Hui Yin, Guang‐Zuan Zhuo, Yong Zhao, Jian‐Hua Ding
Colorectal Disease.2021; 23(2): 424. CrossRef
Broken beer bottle as a cause of sigmoid perforation: A summary of causes and predictors in the management of traumatic and non-traumatic colorectal perforation
Christian German Ospina-Pérez, Ana Milena Álvarez-Acuña, Lina María López-Álvarez, Rosa María Ospina-Pérez, Ivan David Lozada-Martínez, Sabrina Rahman
International Journal of Surgery Case Reports.2021; 85: 106261. CrossRef
Assessment of defecation function after sphincter-saving resection for mid to low rectal cancer: A cross-sectional study
Bao-Jia Luo, Mei-Chun Zheng, Yang Xia, Zhu Ying, Jian-Hong Peng, Li-Ren Li, Zhi-Zhong Pan, Hui-Ying Qin
European Journal of Oncology Nursing.2021; 55: 102059. CrossRef

Colonic Perforation Secondary to Idiopathic Intramural Hemorrhage: Takashi Sakamoto, Akira Saito, Alan Kawarai Lefor, Tadao Kubota; Ann Coloproctol. 2016;32(6):239-242. Published online December 31, 2016; DOI: https://doi.org/10.3393/ac.2016.32.6.239

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Abstract PDF

Intramural colonic hemorrhage is rare and often secondary to trauma or anticoagulation therapy. Idiopathic intramural hemorrhages in the alimentary tract have rarely been reported. While several reports of spontaneous perforation of an intramural rectal hematoma have been published, no reports of spontaneous perforation in the ascending colon due to a hematoma have. We describe a patient with an ascending colonic perforation secondary to spontaneous intramural hemorrhage. The patient is a 35-year-old male, who presented with acute abdominal pain and no history of trauma. An abdominal computed tomography scan showed a high-density area around the ascending colon, and nonoperative management was instituted. On the eighth hospital day, the pain worsened, and abdominal computed tomography scan showed free air. An emergent right hemicolectomy was performed. Intramural hematoma and ischemia with perforation, with no obvious etiology, were found. The patient was discharged on the 14th postoperative day.

Citations

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A case of gastrointestinal perforation following transarterial embolization for an intramural hematoma after cold snare polypectomy of an adenoma in the transverse colon
Yuu Kodama, Yuji Mizokami, Yuzo Toyama, Hiroyasu Kusaka, Gen Maeda, Shingo Asahara, Ryuji Nagahama, Shin‐ichiro Horiguchi, Hiroki Aoyama
DEN Open.2025;[Epub] CrossRef
Giant Proximal Right Colon Submucosal Hematoma Leading to a Large Bowel Obstruction
Arham Siddiqui, Hijab Ahmed, Muhammad H Nazim, Basem Soliman, Izi Obokhare
Cureus.2022;[Epub] CrossRef
Spontaneous colonic perforation in adults: Evaluation of a pooled case series
Ren Chongxi, Ji Jinggang, Shi Yan, Wang Hongqiao, Liu Yan, Yang Fengshuo
Science Progress.2020;[Epub] CrossRef
Idiopathic intramural hematoma of the right colon. A case report and review of the literature
Rosario Vecchio, Emma Cacciola, Michele Figuera, Renato Catalano, Giuseppe Giulla, Emanuele Rosario Distefano, Eva Intagliata
International Journal of Surgery Case Reports.2019; 60: 16. CrossRef
Intramural Hematoma Causing Hematochezia After Colonoscopy With Polypectomy
Aleksandar Gavrić, Rok Dežman, Sebastian Stefanović, Jan Drnovšek, Borut Štabuc
ACG Case Reports Journal.2019; 6(7): e00129. CrossRef

Penetration of the Descending Colon by a Migrating Intrauterine Contraceptive Device: Jung Min Park, Chang Seog Lee, Min Seong Kim, Do Young Kim, Chul Young Kim, Young Bae Lim, Yong Kyu Lee, Dong Eun Park, Dong Hyun Lee; J Korean Soc Coloproctol. 2010;26(6):433-436. Published online December 31, 2010; DOI: https://doi.org/10.3393/jksc.2010.26.6.433

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Abstract PDF

Foreign bodies in the gastrointestinal tract often cause serious complications, such as perforation, obstruction, abscess formation, or hemorrhage. This is a case in which a patient visited our hospital and complained of a vague lower abdominal pain that had been present for three months. She had an intrauterine device (IUD) inserted five years earlier. The abdominal X-ray, computed tomography and colonoscopy revealed that the IUD had penetrated into the descending colon. We tried to remove the IUD by colonoscopy but failed due to pain, so we removed the IUD surgically. Thus, we report a case in which a previously inserted IUD had penetrated into the descending colon and was surgically removed. We also present a brief review of the literature.

Citations

Citations to this article as recorded by

Missing intrauterine device migrated to terminal ileum resembling adnexal mass: A case report
Mohammad Kamal Tani, Wais Farda, Haider Khan, Omer Malikzai, Zabihullah Sharif
International Journal of Surgery Case Reports.2024; 115: 109279. CrossRef
Robotic assisted removal of migrated intrauterine device
Marco Bertucci Zoccali, Osama Jabi
Colorectal Disease.2023; 25(8): 1718. CrossRef
Is It a “Colon Perforation”? A Case Report and Review of the Literature
Shuangshuang Lu, Xinyu Yao, Jun Shi, Jian Huang, Shaohua Zhuang, Junfang Ma, Yan Liu, Wei Zhang, Lifei Yu, Ping Zhu, Qiuwei Zhu, Ruxia Shi, Hong Zheng, Dong Shao, Yuyan Pan, Shizhen Bao, Li Qin, Lijie Huang, Wenjia Liu, Jin Huang
Frontiers in Medicine.2022;[Epub] CrossRef
Intestinal Perforation by a Migrated Intrauterine Contraceptive Device: A Review of This Rare but Important Complication
Antony Zacharias, Stephanie Clark, Chetan Parmar, Ayo Oshowo
SN Comprehensive Clinical Medicine.2021; 3(8): 1759. CrossRef
Incomplete Removal of an Intrauterine Device Perforating the Sigmoid Colon
Junseak Lee, Jung Hwan Oh, Jinsu Kim, Chul-Hyun Lim, Sung Hoon Jung
The Korean Journal of Gastroenterology.2021; 78(1): 48. CrossRef
Rectum migration of an intrauterine device
Rui Li, Hongmei Li, Jie Zhang, Huiqing Li
Journal of Minimal Access Surgery.2021; 17(1): 113. CrossRef
Pelvic abscess complicating sigmoid colon perforation by migrating intrauterine device: A case report and review of the literature
Omar Toumi, Houssem Ammar, Abdessalem Ghdira, Amine Chhaidar, Wided Trimech, Rahul Gupta, Randa Salem, Jamel Saad, Ibtissem Korbi, Mohamed Nasr, Faouzi Noomen, Mondher Golli, Khadija Zouari
International Journal of Surgery Case Reports.2018; 42: 60. CrossRef

A Case of Successful Percutaneous Drainage of a Pelvic Abscess Complicating Colonoscopy.: Si, Youn , Kim, Shin Young , Choi, Seung Bong , Kim, Hyung Jin , Lee, Yoon Suk , Cho, Hyun Min , Kim, Jun Gi , Oh, Seung Tack , Lee, In Kyu; J Korean Soc Coloproctol. 2009;25(5):347-351.; DOI: https://doi.org/10.3393/jksc.2009.25.5.347

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Abstract PDF

Perforations that occur during colonoscopy are usually managed by surgical repair. When the patient's symptoms are mild and laboratory findings show minor abnormalities, a conservative treatment can be considered. Although an operation is the treatment of choice in patients with generalized peritonitis, in some selected patients, percutaneous abscess drainage can be an alternative to surgical intervention for drainage of deep-infected fluid collections or can act as a temporary measure until the patient becomes sufficiently stable for surgery. We report here on a 53-yr-old male patient who developed signs of localized peritonitis and had a pelvic abscess due to a colonic perforation after colonoscopy and was treated successfully by using percutaneous abscess drainage.

Citations

Citations to this article as recorded by

A Case of Buried Bumper Syndrome Complicated by Abdominal Wall Abscess in an Elderly Patient
Chul Young Kim, Min Seong Kim, Do Young Kim, Young Bae Lim, Dong Yoon Kang, Tack Su Yun, Sang Seok Yoon, Jung Hyun Lee, Woo Young Kim, Yong Kyu Lee
Journal of the Korean Geriatrics Society.2010; 14(4): 265. CrossRef

Original Articles

Treatment of Colon Perforation Associated with Colonoscopy.: Park, Hae Ran , Baek, Seong Kyu , Bae, Ok Suk , Park, Sung Dae; J Korean Soc Coloproctol. 2008;24(5):322-328.; DOI: https://doi.org/10.3393/jksc.2008.24.5.322

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Abstract PDF

PURPOSE
Recently, non-operative conservative management or laparoscopic repair has been reported for the management of colonic perforation during colonoscopy. However, the preferred management strategy remains controversial. The purpose of the present study is to identify an appropriate strategy for the treatment of colon perforation during colonoscopy.
METHODS
The medical records of patients who developed colon perforation during colonoscopy between May 2003 and November 2007 were retrospectively reviewed. The mechanism and site of perforation, the treatment administered, complications, and clinical outcomes were analyzed.
RESULTS
In total, 16 perforations were evaluated. Of these, 11 developed during diagnostic colonoscopy and 5 during therapeutic colonoscopy. The most frequent perforation site was the sigmoid colon (12), followed by the transverse colon (2), the rectum (1), and unknown site (1). Six patients underwent surgery due to signs of diffuse peritonitis 10 were initially treated conservatively. Among the patients who underwent surgery, four underwent laparoscopic repair and two underwent open repair. Among the patients initially treated conservatively two patients required surgery due to clinical deterioration of peritonitis and rectovaginal fistula. These 2 patients underwent repair with proximal diverting stomas.
CONCLUSIONS
Colon perforation associated with colonoscopy is a rare event, but raises serious complications. Selected patients with colonoscopic perforation may be treated conservatively, but if these patients fail to respond to such treatments, extensive surgical procedures may be warranted.

Citations

Citations to this article as recorded by

Management Outcomes of Colonoscopic Perforations Are Affected by the General Condition of the Patients
Jae Ho Park, Kyung Jong Kim
Annals of Coloproctology.2018; 34(1): 16. CrossRef
Comparison of the surgical outcomes of laparoscopic versus open surgery for colon perforation during colonoscopy
Jeongsoo Kim, Gil Jae Lee, Jeong-Heum Baek, Won-Suk Lee
Annals of Surgical Treatment and Research.2014; 87(3): 139. CrossRef
A Case of Successful Percutaneous Drainage of a Pelvic Abscess Complicating Colonoscopy
Youn Si, Shin Young Kim, Seung Bong Choi, Hyung Jin Kim, Yoon Suk Lee, Hyun Min Cho, Jun Gi Kim, Seung Tack Oh, In Kyu Lee
Journal of the Korean Society of Coloproctology.2009; 25(5): 347. CrossRef

Prognostic Factors for Generalized Peritonitis Secondary to Colonic Perforation.: Kim, Hong , Lee, Kug Jong , Lee, Young Joo , Suh, Kwang Wook; J Korean Soc Coloproctol. 2003;19(4):216-220.

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Abstract PDF: PURPOSE
The prognosis following colonic perforation is generally regarded as worse than it is for upper gastrointestinal perforation. Moreover, the increasing incidence of colon cancer associated perforation is another reason for the present study of colonic perforation in the present study. We reviewed and analyzed various types of colonic perforations to determine which prognostic factors were still useful for the treatment of colonic perforation.
METHODS
Thirty six patients (mean age, 51.5; 24 males) with generalized peritonitis secondary to a colonic perforation were studied retrospectively. All the patients had undergone an exploratory laparotomy. The severity of the clinical condition was recorded according to the APACHE III scoring system for all the patients when they were first seen. Mortality and morbidity were analyzed for possible prognostic factors, such as age, type of operation, association with malignancy, and APACHE-III score.
RESULTS
Penetrating trauma was the leading cause of perforation (27.8%), and iatrogenic perforations accounted for 19.4% of the total. Among nontraumatic perforations, malignancy was the major pathology (25.0%). The sigmoid colon was the most frequent site of perforation. Types of surgical treatment varied according to the general conditions of the patients. In 22 patients, the operation was finished with primary closure alone. A colonic resection was performed in 14 patients, and a proximal diversion was performed in 19 patients (after either a resection or primary closure). Analysis of the various clinical variables showed that old age (>60), underlying malignancy, and the APACHE III score were significant prognostic factors for the surgical outcome.
CONCLUSIONS
These results suggest that penetrating injuries are still the main cause of colonic perforation and that iatrogenic and malignancy-related perforations are increasing. Among other variables, old age, underlying malignancy and the APACHE III score are significant prognostic factors for the surgical outcome.

Clinical Analysis of Stercoral Perforation of Colon.: Jung, Cheol Woong , Hong, Jeong Hun , Min, Byung Wook , Moon, Hong Young; J Korean Soc Coloproctol. 2002;18(4):229-233.

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Abstract PDF: PURPOSE
Stercoral perforation of colon is a rare disease with poor prognosis. But according to recent reports, the incidence of stercoral perforation in the colon seemed to have been underestimated. The reason might be the lack of recognition and overlook by surgeons. The purposes of this study were to represent the definition of stercoral perforation, and to help the diagnosis and treatment of stercoral perforation.
METHODS
Among the patients who underwent emergency operation for colon perforation at the Department of Surgery, Korea University College of Medicine, from January 1992 to December 2001, 9 patients were diagnosed as stercoral perforation and their medical records were reviewed retrospectively regarding the clinical characteristics, managements and mortality.
RESULTS
The age distribution of the patients was from 32 to 76 years. Male to female ratio was 1.3:1. All patients had history of chronic constipation. Six cases (33.3%) had free air, and 5 cases (55.6%) had fecaloma at preoperative simple X-ray. The site of perforation were sigmoid colon (8 cases) and descending colon (1 case). The size of perforation ranged from 1 cm to 6.5 cm (mean: 3.1 2.7 cm). The methods of operation were Hartmann's procedure (8 cases), primary repair and sigmoid loop colostomy (1 case). There were two deaths for sepsis.
CONCLUSIONS
The stercoral perforation is not rare as commonly thought. If elderly patients who had history of chronic constipation and symptoms of panperitonitis visit hospital, surgeon should be aware of the possibility of this fatal disease and do early surgical intervention with the aggressive therapy for reducing the mortality.

Colon Perforation.: Choi, Kwang Ho , Hong, Yun Sik , Suh, Sung Ock , Moon, Hong Young; J Korean Soc Coloproctol. 1999;15(4):307-314.

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Abstract PDF: PURPOSE
To evaluate factors that predict prognosis of colon perforation, we review the hospital records of 37 patients who underwent emergency operation for colon perforation.
METHODS
Information of clinical findings, Acute Physiology and Chronic Health Evaluation (APACHE II score), perforation sites and causes, operation methods, and postoperative complications were obtained.
RESULTS
The causes of perforation were traumatic 11 (29.7%), iatrogenic 10 (27.0%), diverticular 6 (16.2%), cancerous process 6 (16.2%), strangulated hernia 2 (5.4%), ischemic colitis 1 (2.7%) and stercoral 1 (2.7%). The longer duration from colon perforation to operation, the more severe intra-abdominal fecal contamination was seen. The complication rate was increased as the intra-abdominal fecal contamination increased or APACHE II score increased (p<0.05). But there were no correlation between the complication rate and perforation sites and causes. In according to operative managements, one-stage operation (simple closure or resection with anastomosis) group had more lower complication rate than two-stage operation (formation of colostomy) group, unexpectedly (31.3% vs. 52.4%, p>0.05). Also former group had lower complication rate compared to latter group in left colon (40% vs 50%).
CONCLUSIONS
The factors that predict of mortality and morbidity are not perforation site, causes, and operation method, but preoperative physiologic status (APACHE II score) and intra-abdominal fecal contamination. So preoperative proper and vigorous treatment for improvement of physiologic status and shortening of interval to operation are important for better results. And primary closure and resection with anastomosis is useful for colon perforation in selected circumstance regardless of its site and cause.

One Stage Operation of Colon Perforation.: Yoon, Dae Kun , Shim, Kang Sup , Kim, Kwang Ho , Park, Eung Bum; J Korean Soc Coloproctol. 1998;14(3):493-502.

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Abstract PDF: Colon has the highest bacterial concentration in the gastrointestinal tract. When the colon is perforated, the operator has to decide whether to perform primary closure, resection with anastomosis, proximal colostomy, and exteriorizatoion. In this retrospective study, from October, 1993, through July 1998, 56 patient with panperitonitis due to colon perforation were operated at Ewha womans University medical center. The rectal perforation was limited the intraperitoneal portion. Our cases were divided into two groups. Group I included 34 patients who treated with one step operations of primaryrepair or resection anastomosis. Group II included 22 patients who treated with two step operations of proximal colostomy or exteriorization. The one step operations were performed in 34 patients, proximal colostomy in 21 patients, and exteriorization in 1 patient. There was 13.7% in the incidence of motality and 33.3% in the incidence of morbidity. The Chi-square test was used to evaluate the significance of differences between two groups. Independent risk factors for adverse outcomes were compared and used to analyse the probability for adverse outcomes with respect to the mode of treatmen. The mode of treatment was not dependent on the risk factors. These results suggest that one could select positively primary closure or resection with anastomosis for the treatment of patients with panperitonitis due to colon perforation.

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