Annals of Coloproctology

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Case Reports

Malignant disease,Rare disease & stoma,Complication

Colonic Perforation After Treatment With Nivolumab in Esophageal Cancer: A Case Report: Hye Jung Cho, Woo Ram Kim, Joo-Hang Kim, Duk Hwan Kim, Dae Jung Kim, Haeyoun Kang; Ann Coloproctol. 2021;37(Suppl 1):S39-S43. Published online June 24, 2021; DOI: https://doi.org/10.3393/ac.2020.00213.0030

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With the advent of checkpoint inhibitors, it has opened up opportunities for numerous cancer patients. However, as is the case with every treatment, complications need to be weighed. Gastrointestinal adverse effects, such as diarrhea and colitis are well-known complications for checkpoint inhibitors. In severe cases, colitis-induced colonic perforation may occur with an estimation of 1.0% to 1.5% in anti-CTLA-4 antibodies. However, only a handful of cases of such devastating complications have been reported in anti-PD-1 antibodies such as pembrolizumab and nivolumab. We here report a case of intestinal perforation in a patient treated with nivolumab.

Citations

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Intestinal perforation in recurrent cervical cancer following bevacizumab and pembrolizumab therapy: A case report
Yuanchun Fan, Shihao Liu, Jiangjing Zhao, Yawei Fu, Jiahui Yang, Chunyang Wang, Hui Zhang
Medicine.2025; 104(15): e40473. CrossRef
Iatrogenic effect of immune checkpoint inhibitors and targeted therapies on the lower gastrointestinal tract
Dua Abuquteish, Ahmad Yousef Alazzam, Aws Khalid Abushanab, Omar Amjad Almajdoubah, Sara Aljfout, Mahmoud Taysir Mousa, Mus’ab Theeb Mustafa, Bashar Khater, Maher Sughayer
Frontline Gastroenterology.2025; : flgastro-2025-103094. CrossRef
Chemotherapy-associated pneumoperitoneum in cancer patients: a scoping review
Renee M. Maina, Caroline Rader, Jeevan Kypa, Constantine Asahngwa, Hilary M. Jasmin, Nia N. Zalamea, John S. Nelson, Jonathan L. Altomar, Mary Brinson Owens, Clarisse S. Muenyi, Denis A. Foretia
Annals of Medicine & Surgery.2024; 86(5): 2828. CrossRef
Update on immunotherapy‐mediated colitis: Clinical features, mechanisms, and management
Dandan Wang, Yiwei Zhao, Yiyun Zeng, Lanlin Hu, Chuan Xu
Malignancy Spectrum.2024; 1(4): 225. CrossRef
Gastrointestinal perforation associated with novel antineoplastic agents: A real-world study based on the FDA Adverse Event Reporting System
Zicheng Yu, Haibin Zhu, Hongjun Chen, Lifei Zhu, Xiaolan Liao
Journal of Pharmacy & Pharmaceutical Sciences.2023;[Epub] CrossRef
Gastrointestinal and Hepatobiliary Immune-related Adverse Events: A Histopathologic Review
Zainab I. Alruwaii, Elizabeth A. Montgomery
Advances in Anatomic Pathology.2023; 30(3): 230. CrossRef
An updated review of gastrointestinal toxicity induced by PD-1 inhibitors: from mechanisms to management
Yiyu Cheng, Fangmei Ling, Junrong Li, Yidong Chen, Mingyang Xu, Shuang Li, Liangru Zhu
Frontiers in Immunology.2023;[Epub] CrossRef
Nivolumab

Reactions Weekly.2022; 1892(1): 181. CrossRef
Gastrointestinal and Hepatobiliary Immune-related Adverse Events: A Histopathologic Review
Zainab I. Alruwaii, Elizabeth A. Montgomery
Advances in Anatomic Pathology.2022; 29(4): 183. CrossRef

Benign GI diease

Small Bowel Perforation Associated With Gastrointestinal Graft-Versus-Host Disease and Cytomegalovirus Enteritis in a Patient With Leukemia: A Case Report With Literature Review: Kwang-Seop Song, Min Jung Kim, Han-Ki Lim, Yoon Hwa Hong, Sung Sil Park, Chang Won Hong, Sung Chan Park, Dae Kyung Sohn, Kyung Su Han, Jae Hwan Oh; Ann Coloproctol. 2020;36(4):281-284. Published online August 31, 2020; DOI: https://doi.org/10.3393/ac.2018.10.01.1

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Gastrointestinal graft-versus-host disease (GVHD) is a common complication after hematopoietic stem cell transplantation. Concomitant cytomegalovirus (CMV) enteritis worsens the prognosis of this condition. We report a case of small bowel perforation associated with gastrointestinal GVHD and CMV enteritis in a patient with leukemia who was successfully treated surgically. A 39-year-old man presented with intestinal perforation necessitating emergency surgical intervention. He was diagnosed with T-cell acute lymphoblastic leukemia and developed severe gastrointestinal GVHD and CMV enteritis after hematopoietic stem cell transplantation. His terminal ileum showed a perforation with diffuse wall thinning, and petechiae were observed over long segments of the distal ileum and the proximal colon. Small bowel segmental resection and a subtotal colectomy with a double-barreled ileocolostomy were performed. The patient recovered uneventfully after the operation. Based on reports described in the literature, surgery plays a minor role in the management of gastrointestinal GVHD; however, timely surgical intervention could be effective in selected patients.

Citations

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Cytomegalovirus enteritis resistant to antiviral drugs improved following total colectomy
Sae Kawata, Jumpei Takamatsu, Yuichi Yasue, Aya Fukuhara, Jinkoo Kang
Surgical Case Reports.2023;[Epub] CrossRef

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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Abstract PDF

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.

Citations

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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

Benign GI diease,Rare disease & stoma,Complication

Intestinal Perforation as a Paradoxical Reaction to Antitubercular Therapy: A Case Report: Sung Hoon Kang, Hee Seok Moon, Jae Ho Park, Ju Seok Kim, Sun Hyung Kang, Eaum Seok Lee, Seok Hyun Kim, Byung Seok Lee, Jae Kyu Sung, Hyun Yong Jeong, Kyung Ha Lee; Ann Coloproctol. 2021;37(Suppl 1):S18-S23. Published online May 15, 2020; DOI: https://doi.org/10.3393/ac.2020.03.16.1

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Paradoxical reactions to tuberculosis (TB) treatment are characterized by an initial improvement of the clinical symptoms followed by clinical or radiological deterioration of existing tuberculous lesions, or by development of new lesions. Intestinal perforation in gastrointestinal TB can occur as a paradoxical reaction to antitubercular therapy. A 55-year-old man visited the outpatient department with lower abdominal pain and weight loss. He was diagnosed with intestinal TB and started antitubercular therapy. After 3 months of antitubercular therapy, a colonoscopy revealed improvement of the disease. Three days after the colonoscopy, the patient visited the emergency room complaining of abdominal pain. Abdominal computed tomography revealed extraluminal air-filled spaces in the pelvic cavity. We diagnosed a small bowel perforation and performed an emergency laparotomy and a right hemicolectomy with small bowel resection. This report describes the case of intestinal perforation presenting as a paradoxical reaction to antitubercular and provides a brief literature review.

Citations

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Paradoxical ileocecal perforation during early anti-tuberculosis therapy: A rare case report
Yoseph Mulatu Habte, Binyam Mulatu Habte, Yabetse Alemayehu Kifle, Esimael Musema Abdu, Makida Mulatu Habte, Shimelis Ayalew Yimer
International Journal of Surgery Case Reports.2025; 137: 112100. CrossRef
Réaction paradoxale tuberculeuse
L.-D. Azoulay, A.-L. Houist, E. Feredj, W. Vindrios, S. Gallien
La Revue de Médecine Interne.2024; 45(5): 279. CrossRef
Left hand abscess as a paradoxical reaction during treatment of disseminated tuberculosis in immunocompetent patient: case report and review of literature
Aisha Alharbi, Aseel Aljahdali, Mohamed Firoze Ahamed, Hassan Almarhabi
BMC Infectious Diseases.2024;[Epub] CrossRef
Paradoxical Reaction to Antitubercular Treatment Causing Colonic Obstruction
Akira Hokama, Yuiko Oishi, Erika Koga, Sayuri Takehara, Jiro Fujita
Chonnam Medical Journal.2022; 58(1): 52. CrossRef
Multiple drugs

Reactions Weekly.2021; 1881(1): 189. CrossRef

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

Pneumatic Colorectal Injury Caused by High Pressure Compressed Air: Jin Young Lee, Young Hoon Sul, Seung Je Go, Jin Bong Ye, Jung Hee Choi; Ann Coloproctol. 2019;35(6):357-360. Published online May 22, 2019; DOI: https://doi.org/10.3393/ac.2018.08.19

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The pneumatic colorectal injury caused by high pressure compressed air are rare and can be fatal. Herein, we present a case of 45-year-old male who developed sudden onset of severe abdominal pain after cleaning the dust on his pants with high pressure compressed air gun dust cleaner. Emergent exploratory laparotomy was done which findings are a huge rectal perforation with multiple serosal and subserosal tear in sigmoid to splenic flexure of colon. Anterior resection with left hemicolectomy, and temporary transverse colostomy was performed. Postoperative course was uneventful. Recently, prognosis is generally favorable because of prompt diagnosis and emergent surgical management.

Citations

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Laparoscopic Repair of Colorectal Perforations Induced by Compressed Air Pressure: A Case Report
Ibrahim Elnogoomi, Hoorieh Qasemi, Mariam Aylan Alshamsi, Majid Alhammadi, Omar Elnogoomi
Cureus.2024;[Epub] CrossRef
Air Nozzle Injury: Barotrauma Resulted From an Industrial Accident
Ashok N Mhaske, Nishi Gupta, Abhishek Mishra, Shubham Jaiswal, Chirag Dausage, Jyoti Meena, Gourav Goyal
Cureus.2024;[Epub] CrossRef
Emergency laparoscopic resection of the anterior rectum due to rectal trauma secondary to compressed air, case report
Daniel Gómez, Luis F. Cabrera, Mauricio Pedraza, Andres Mendoza-Zuchini, Nicolás Sánchez, Hector W. Cure, Héctor O. Cure Bulicie, Jean A. Pulido
International Journal of Surgery Case Reports.2020; 76: 288. 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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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.

Citations

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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

Original Article

Management Outcomes of Colonoscopic Perforations Are Affected by the General Condition of the Patients: Jae Ho Park, Kyung Jong Kim; Ann Coloproctol. 2018;34(1):16-22. Published online February 28, 2018; DOI: https://doi.org/10.3393/ac.2018.34.1.16

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Purpose

The management of a colonoscopic perforation (CP) varies from conservative to surgical. The objective of this study was to evaluate the outcomes between surgical and conservative treatment of patients with a CP.

Methods

From 2003 to 2016, the medical records of patients with CP were retrospectively reviewed. Patients were divided into 2 groups depending on whether they initially received conservative or surgical treatment.

Results

During the study period, a total of 48 patients with a CP were treated. Among them, 5 patients had underlying colorectal cancer and underwent emergency radical cancer surgery; these patients were excluded. The mean age of the remaining 43 patients was 64.5 years old, and the most common perforation site was the sigmoid colon (15 patients). The initial conservative care group included 16 patients, and the surgery group included 27 patients. In the conservative group, 5 patients required conversion to surgery (failure rate: 5 of 16 [31.3%]). Of the surgery group, laparoscopic surgery was performed on 19 patients and open surgery on 8 patients, including 2 conversion cases. Major postoperative complications developed in 11 patients (34.4%), and postoperative mortality developed in 4 patients (12.5%). The only predictor for poor prognosis after surgery was a high American Society of Anesthesiologists physical status classification.

Conclusion

In this study, conservative treatment for patients with a CP had a relatively high failure rate. Furthermore, surgical treatment showed significant rates of complications and mortality, which depended on the general status of the patients.

Citations

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Multicenter retrospective evaluation of ileocecocolic perforations associated with diagnostic lower gastrointestinal endoscopy in dogs and cats
Vanessa L. Woolhead, Jacqueline C. Whittemore, Sarah A. Stewart
Journal of Veterinary Internal Medicine.2020; 34(2): 684. CrossRef

Case Reports

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

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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

Urinary Bladder Injury During Colonoscopy Without Colon Perforation: Jung Wook Suh, Jun Won Min, Hwan Namgung, Dong-Guk Park; Ann Coloproctol. 2017;33(3):112-114. Published online June 30, 2017; DOI: https://doi.org/10.3393/ac.2017.33.3.112

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We report a case of urinary bladder perforation during colonoscopy. A 67-year-old female, who had undergone a transabdominal hysterectomy for uterine myomas 15 years ago, visited the emergency department with complaint of abdominal pain after a screening colonoscopy. Laparoscopic examination revealed severe adhesion between the sigmoid colon and the urinary bladder. The urinary bladder wall was weakened, and several perforation sites were found. The surgery was converted to a laparotomy. After a thorough examination, we performed primary repair for the perforation sites, followed by an omentopexy.

Citations

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Trauma to the solid abdominal organs: The missed dark box of colonoscopy
Mohamed H Emara, Usama Mazid, Yasmine A Elshaer, Mahmoud A Elkerdawy, Dilaver Farooq Malik, Aya M Mahros
World Journal of Gastroenterology.2024; 30(7): 624. CrossRef
Mesenteric laceration of the sigmoid colon after colonoscopy: A rare complication
Min Wu, Yonghua Lin, Zhichao Chen, Jianfeng Wei
Asian Journal of Surgery.2023; 46(11): 5391. CrossRef
Massive retroperitoneal hematoma following colonoscopy
Reo Ohtsuka, Hodaka Amano, Kei Niida, Takeaki Yoshino, Michiyo Owari, Ryotaro Takano, Yuichi Akama, Yohei Watanabe, Toshiyasu Iwao
Medicine.2018; 97(31): e11723. 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.

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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

Pneumoretroperitoneum, Pneumomediastinum, Subcutaneous Emphysema After a Rectal Endoscopic Mucosal Resection: Hee Cheul Jung, Hyun Jin Kim, Sung Bok Ji, Jun Hyeong Cho, Ji Hye Kwak, Chang Min Lee, Wan Soo Kim, Jin Ju Kim, Jae Min Lee, Sang Su Lee; Ann Coloproctol. 2016;32(6):234-238. Published online December 31, 2016; DOI: https://doi.org/10.3393/ac.2016.32.6.234

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Abstract PDF

An endoscopic mucosal resection (EMR) is an effective and safe therapeutic technique for treating a patient with a laterally-spreading tumor (LST). Colonoscopic-procedure-related complications are noted to be about 2.8% worldwide, and a perforation is the most common. Most colon perforations cause pneumoperitoneum. However, a perforation within the retroperitoneal portion of the colon (rectum and some of sigmoid colon) may cause an extraperitoneal perforation, and the leaking free air may induce pneumoretroperitoneum, pneumomediastinum, and subcutaneous emphysema, depending on the amount of discharged air. Herein, we present the case of a patient with an extraperitoneal colon microperforation which manifested as pneumoretroperitoneum, pneumomediastinum, and subcutaneous emphysema after an EMR for a sigmoid LST, which was successfully treated with medical treatment and endoscopic clipping.

Citations

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Asymptomatic sigmoid diverticulum perforation-induced subcutaneous, mediastinal, and retroperitoneal emphysema: A case report and literature review
Daichi Setoguchi, Naoki Iwanaga, Kotaro Nema, Tomoya Hagiwara, Kotaro Hayashida, Koki Yamashita, Tatsuro Hirayama, Masataka Yoshida, Kazuaki Takeda, Shotaro Ide, Masato Tashiro, Takahiro Takazono, Masachika Kitajima, Noriho Sakamoto, Koichi Izumikawa, Kat
Respiratory Medicine Case Reports.2025; 56: 102229. CrossRef
Pneumoretroperitoneum mimicking rectal perforation, secondary to vaginal wall laceration following sexual intercourse in a 19-year-old woman in Korea: a case report
Sung Pil Choo, Ki Eun Seon, Jae Cheol Jung, Kyeong Deok Kim, Moon Suk Choi
Journal of Acute Care Surgery.2025; 15(2): 86. CrossRef
The Close Relationship between Large Bowel and Heart: When a Colonic Perforation Mimics an Acute Myocardial Infarction
Maria Francesca Secchi, Carlo Torre, Giovanni Dui, Francesco Virdis, Mauro Podda
Case Reports in Surgery.2018; 2018: 1. CrossRef
Pneumoretroperitoneum, Pneumomediastinum, Pneumothorax, and Subcutaneous Emphysema after Diagnostic Colonoscopy
Hee Sung Lee, Hwan Hee Park, Ju Seok Kim, Sun Hyung Kang, Hee Seok Moon, Jae Kyu Sung, Byung Seok Lee, Hyun Yong Jeong
The Korean Journal of Gastroenterology.2017; 70(3): 145. CrossRef

Original Articles

Predictors of Morbidity and Mortality After Surgery for Intestinal Perforation: Rumi Shin, Sang Mok Lee, Beonghoon Sohn, Dong Woon Lee, Inho Song, Young Jun Chai, Hae Won Lee, Hye Seong Ahn, In Mok Jung, Jung Kee Chung, Seung Chul Heo; Ann Coloproctol. 2016;32(6):221-227. Published online December 31, 2016; DOI: https://doi.org/10.3393/ac.2016.32.6.221

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Abstract PDF

Purpose

An intestinal perforation is a rare condition, but has a high mortality rate, even after immediate surgical intervention. The clinical predictors of postoperative morbidity and mortality are still not well established, so this study attempted to identify risk factors for postoperative morbidity and mortality after surgery for an intestinal perforation.

Methods

We retrospectively analyzed the cases of 117 patients who underwent surgery for an intestinal perforation at a single institution in Korea from November 2008 to June 2014. Factors related with postoperative mortality at 1 month and other postoperative complications were investigated.

Results

The mean age of enrolled patients was 66.0 ± 15.8 years and 66% of the patients were male. Fifteen patients (13%) died within 1 month after surgical treatment. Univariate analysis indicated that patient-related factors associated with mortality were low systolic and diastolic blood pressure, low serum albumin, low serum protein, low total cholesterol, and high blood urea nitrogen; the surgery-related factor associated with mortality was feculent ascites. Multivariate analysis using a logistic regression indicated that low systolic blood pressure and feculent ascites independently increased the risk for mortality; postoperative complications were more likely in both females and those with low estimated glomerular filtration rates and elevated serum C-reactive protein levels.

Conclusion

Various factors were associated with postoperative clinical outcomes of patients with an intestinal perforation. Morbidity and mortality following an intestinal perforation were greater in patients with unstable initial vital signs, poor nutritional status, and feculent ascites.

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The Outcomes of Management for Colonoscopic Perforation: A 12-Year Experience at a Single Institute: Jung Yun Park, Pyong Wha Choi, Sung Min Jung, Nam-Hoon Kim; Ann Coloproctol. 2016;32(5):175-183. Published online October 31, 2016; DOI: https://doi.org/10.3393/ac.2016.32.5.175

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Abstract PDF

Purpose

Optimal management of colonoscopic perforation (CP) is controversial because early diagnosis and prompt management play critical roles in morbidity and mortality. Herein, we evaluate the outcomes and clinical characteristics of patients with CP according to treatment modality to help establish guidelines for managing CP.

Methods

Our retrospective analysis included 40 CP patients from January 1, 2003, to December 31, 2014. Patients with CP were categorized into 2 groups according to therapeutic modality: operation (surgery) and nonoperation (endo-luminal clip application or conservative treatment) groups.

Results

The postoperative morbidity rate was 40%, and no mortalities were noted. The incidence of abdominal pain and tenderness in patients who received only conservative management was significantly lower than in those who underwent surgery (P < 0.001 and P = 0.004, respectively). Patients tended to undergo surgery more often for diagnosis times longer than 24 hours and for diagnostic CPs. The mean hospital stays for the operation and nonoperation groups were 14.6 ± 7.77 and 5.9 ± 1.62 days, respectively (P < 0.001). Compared to the operation group, the nonoperation group began intake of liquid diets significantly earlier after perforation (3.8 ± 1.32 days vs. 5.6 ± 1.25 days, P < 0.001) and used antibiotics for a shorter duration (4.7 ± 1.29 days vs. 8.7 ± 2.23 days, P < 0.001).

Conclusion

The time of diagnosis and the injury mechanism may be useful indications for conservative management. Nonoperative management, such as endo-luminal clip application, might be beneficial, when feasible, for the treatment of patients with CP.

Citations

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Gut and Liver.2025; 19(1): 95. CrossRef
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Laparoscopic versus open surgery for colonoscopic perforation: A systematic review and meta-analysis
Wu Zhong, Chuanyuan Liu, Chuanfa Fang, Lei Zhang, Xianping He, Weiquan Zhu, Xueyun Guan
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Analysis of the Characteristics of Colonoscopy Perforation and Risk Factors for Failure of Endoscopic Treatment
Zhi Jiehua, Ali Kashif , Che YaoSheng , Sun YunYun , Liang Lanyu
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Iatrogenic colon perforation during colonoscopy, diagnosis/treatment, and follow-up processes: A single-center experience
Nihat Gülaydın, Raim İliaz, Atakan Özkan, A Hande Gökçe, Hanifi Önalan, Berrin Önalan, Aziz Arı
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ESTUDO RETROSPECTIVO DA PREVALÊNCIA DE PERFURAÇÕES GASTROINTESTINAIS EM PACIENTES SUBMETIDOS A COLONOSCOPIAS NO HOSPITAL REGIONAL HANS DIETER SCHMIDT
Viviane Helena Raimundo, Paula Fernanda Partika, Haroldo Luiz Jordelino da Luz, Eduardo Manoel Pereira
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Adverse events related to colonoscopy: Global trends and future challenges
Su Young Kim, Hyun-Soo Kim, Hong Jun Park
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Iatrogenic Colonic Perforations: Changing the Paradigm
Jose Luis Ulla-Rocha, Angel Salgado, Raquel Sardina, Raquel Souto, Raquel Sanchez-Santos, Juan Turnes
Surgical Laparoscopy, Endoscopy & Percutaneous Techniques.2019; 29(3): 173. CrossRef
Diagnosis and Management of Colonoscopy-related Perforation
Nam Seok Ham, Jung Ho Bae, Dong-Hoon Yang
The Korean Journal of Gastroenterology.2019; 73(6): 327. CrossRef
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
2017 WSES guidelines for the management of iatrogenic colonoscopy perforation
Nicola de’Angelis, Salomone Di Saverio, Osvaldo Chiara, Massimo Sartelli, Aleix Martínez-Pérez, Franca Patrizi, Dieter G. Weber, Luca Ansaloni, Walter Biffl, Offir Ben-Ishay, Miklosh Bala, Francesco Brunetti, Federica Gaiani, Solafah Abdalla, Aurelien Ami
World Journal of Emergency Surgery.2018;[Epub] CrossRef

Case Report

Proper Management for Morbid Iatrogenic Retroperitoneal Barium Insufflation: Jalal Vahedian-Ardakani, Shahram Nazerani, Amir Saraee, Ali Sarmast, Ehsan Saraee, Mohammad Reza Keramati; Ann Coloproctol. 2014;30(6):285-289. Published online December 31, 2014; DOI: https://doi.org/10.3393/ac.2014.30.6.285

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2 Web of Science
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Abstract PDF

A barium enema is a diagnostic and therapeutic procedure commonly used for colon and rectum problems. Rectal perforation with extensive intra- and/or extraperitoneal spillage of barium is a devastating complication of a barium enema that leads to a significant increase in patient mortality. Due to the low number of reported cases in recent scientific literature and the lack of experience with the management of these cases, we would like to present our treatment approach to a rare case of retroperitoneal contamination with barium, followed by its intraperitoneal involvement during a diagnostic barium enema. Our experience with long-term management of the patient and the good outcome will be depicted in this paper.

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Original Article

Prompt Management Is Most Important for Colonic Perforation After Colonoscopy: Hyun-Ho Kim, Bong-Hyeon Kye, Hyung-Jin Kim, Hyeon-Min Cho; Ann Coloproctol. 2014;30(5):228-231. Published online October 28, 2014; DOI: https://doi.org/10.3393/ac.2014.30.5.228

10,202 View
91 Download
19 Web of Science
15 Citations

Abstract PDF

Purpose

The incidence of complications after colonoscopy is very low. The complications after colonoscopy that are of clinical concern are bleeding and perforation. The present study was conducted to determine the clinical outcomes and the risk factors of a colostomy or a colectomy after colonoscopic colon perforation.

Methods

From March 2009 to December 2012, the records of all patients who were treated for colorectal perforation after colonoscopy were reviewed retrospectively. The following parameters were evaluated: age, sex, purpose of colonoscopy, management of the colonic perforation, and interval from colonoscopy to the diagnosis of a colonic perforation. A retrospective analysis was performed to determine the risk factors associated with major surgery for the treatment of a colon perforation after colonoscopy.

Results

A total 27 patients were included in the present study. The mean age was 62 years, and 16 were males. The purpose of colonoscopy was diagnostic in 18 patients. The most common perforation site was the sigmoid colon. Colonic perforation was diagnosed during colonoscopy in 14 patients, just after colonoscopy in 5 patients, and 24 hours or more after colonoscopy in 8 patients. For the treatment of colonic perforation, endoscopic clipping was performed in 3 patients, primary closure in 15 patients, colon resection in 2 patients, Hartmann's procedures in 4 patients, and diverting colostomy in 3 patients. If the diagnosis of perforation after colonoscopy was delayed for more than 24 hours, the need for major treatment was increased significantly.

Conclusion

Although a colonic perforation after colonoscopy is rare, if the morbidity and the mortality associated with the colonic perforation are to be reduced, prompt diagnosis and management are very important.

Citations

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Therapeutic Advances in Gastrointestinal Endoscopy.2025;[Epub] CrossRef
Iatrogenic colon perforation during colonoscopy, diagnosis/treatment, and follow-up processes: A single-center experience
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Turkish Journal of Surgery.2022; 38(3): 221. CrossRef
Multicenter retrospective evaluation of ileocecocolic perforations associated with diagnostic lower gastrointestinal endoscopy in dogs and cats
Vanessa L. Woolhead, Jacqueline C. Whittemore, Sarah A. Stewart
Journal of Veterinary Internal Medicine.2020; 34(2): 684. CrossRef
Clinical Characteristics of Colonoscopic Perforation and Risk Factors for Complications After Surgical Treatment
Liang Li, Bing Xue, Chunxia Yang, Zhongbo Han, Hongqiang Xie, Meng Wang
Journal of Laparoendoscopic & Advanced Surgical Techniques.2020; 30(11): 1153. CrossRef
Treatment of colonoscopic perforation: outcomes from a major single tertiary institution
Carolyn R. Chew, Justin M. C. Yeung, Ian G. Faragher
ANZ Journal of Surgery.2019; 89(5): 546. CrossRef
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Jose Luis Ulla-Rocha, Angel Salgado, Raquel Sardina, Raquel Souto, Raquel Sanchez-Santos, Juan Turnes
Surgical Laparoscopy, Endoscopy & Percutaneous Techniques.2019; 29(3): 173. CrossRef
Concurrent retroperitoneal, mediastinal, cervical and subcutaneous emphysema secondary to iatrogenic sigmoid colon perforation
Zehui Wu, Huaping Xu, Yisheng Zhang, Lianghui Shi
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The American Journal of Surgery.2018; 215(4): 712. CrossRef
2017 WSES guidelines for the management of iatrogenic colonoscopy perforation
Nicola de’Angelis, Salomone Di Saverio, Osvaldo Chiara, Massimo Sartelli, Aleix Martínez-Pérez, Franca Patrizi, Dieter G. Weber, Luca Ansaloni, Walter Biffl, Offir Ben-Ishay, Miklosh Bala, Francesco Brunetti, Federica Gaiani, Solafah Abdalla, Aurelien Ami
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Management Outcomes of Colonoscopic Perforations Are Affected by the General Condition of the Patients
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Case Reports

Transanal Evisceration Caused by Rectal Laceration: Aleix Martínez Pérez, María Teresa Torres Sánchez, Jose Manuel Richart Aznar, Eva María Martí Martínez, Manuel Martínez-Abad; Ann Coloproctol. 2014;30(1):47-49. Published online February 28, 2014; DOI: https://doi.org/10.3393/ac.2014.30.1.47

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3 Web of Science
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Abstract PDF

Transrectal evisceration caused by colorectal injury is an unusual entity. This pathology is more frequent in elderly patients and it is usually produced spontaneously. Rectal prolapse is the principal predisposing factor. An 81-year-old woman was taken to the hospital presenting exit of intestinal loops through the anus. After first reanimation measures, an urgent surgery was indicated. We observed the absence of almost every small intestine loop in the abdominal cavity; these had been moved to the pelvis. After doing the reduction, a 3 to 4 cm linear craniocaudal perforation in upper rectum was objectified, and Hartmann's procedure was performed. We investigated and knew that she frequently manipulate herself to extract her faeces. The fast preoperative management avoided a fatal conclusion or an extensive intestinal resection. Reasons that make us consider rectal self-injury as the etiologic factor are explained.

Citations

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S Hajiev, A Ezzat, V Sivarajah, G Reese, N El-Masry
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Adama Sanou, Moussa Bazongo, Edgar Ouangré, Maurice Zida, Gilbert Patindé Bonkoungou, Rodrique Namékinsba Doamba, Sylvain Wendmi Karfo, Elie Yamba Sawadogo, Nayi Zongo, Si Simon Traoré
Surgical Science.2016; 07(07): 291. CrossRef

A Stercoral Perforation of the Rectum: Seung-Jin Kwag, Sang-Kyung Choi, Ji-Ho Park, Eun-Jung Jung, Chi-Young Jung, Sang-Ho Jung, Young-Tae Ju; Ann Coloproctol. 2013;29(2):77-79. Published online April 30, 2013; DOI: https://doi.org/10.3393/ac.2013.29.2.77

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A stercoral perforation of the rectum due to a fecaloma is a rare disease with a high mortality rate. Although multiple case reports of colonic perforations have been published, the data regarding rectal perforations are limited. This case report will highlight one such case of a stercoral rectal perforation that was successfully treated with a laparoscopic operation.

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Stercoral Colitis: Review of Imaging Features and Complications
Nikitha Karkala, Bertin Mathai, John J. Hines, Sarah Byun, Douglas S. Katz
RadioGraphics.2025;[Epub] CrossRef
Rectal stercoral perforation: an uncommon anatomical localization of a rare surgical emergency
Tom Vandaele, Lisa Dekoninck, Pauline Vanhove, Bart Devos, Mathieu Vandeputte, Marc Philippe, Johan Vlasselaers
Journal of Surgical Case Reports.2024;[Epub] CrossRef
Sepsis de origen abdominal secundaria a perforación estercoral recto-sigmoidea: a propósito de un caso
Juan Daniel Serrano-Lizarazo, María Camila Ayala-Gutiérrez, Diana Clemencia Quintero-Gamboa, Andrea Juliana Pinto-Arias, Juan Paulo Serrano-Pastrana
Revista Médicas UIS.2024;[Epub] CrossRef
The Extremes of Constipation: A Case of Stercoral Perforation From Fecal Impaction in a Teenager
Felicia Lee, Jasmin Cao, Evan Lin, Maho Kurashima, Raymond I Okeke, Christian Saliba, Shin Miyata
Cureus.2023;[Epub] CrossRef
Stercoral re-perforation after colostomy takedown: a case report
Seunghwan Lee, Chang Woo Kim
BMC Surgery.2021;[Epub] CrossRef
Rare but relevant: a systematic review of stercoral perforation
Sherwin Fernando, Diwakar R Sarma
British Journal of Hospital Medicine.2021; 82(4): 1. CrossRef
Pelvic Rectal Stercoral Perforation Resulting in Diffuse Pneumatosis
Anupam K Gupta, Oscar A Vazquez, Miguel Lopez-Viego
Cureus.2020;[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
Acute Spontaneous Perforation of Rectosigmoid Junction in a Patient with Quadriplegia following Spinal Cord Injury
Oshan Basnayake, Chiran Rathnaweera, Umesh Jayarajah, Gishanthan Shanthamoorthy, Heshan Dayantha Siriwardena, Asela Jayathilaka, Paola De Nardi
Case Reports in Surgery.2020; 2020: 1. CrossRef
Stercoral perforation: A rare entity
Nisarg Mehta, Ahan Bhatt, Cici Zhang
World Journal of Colorectal Surgery.2019; 8(4): 114. CrossRef
Stercoral Perforation of the Colon: A Potentially Fatal Complication of Opioid-Induced Constipation
Andrew Davies, Katherine Webber
Journal of Pain and Symptom Management.2015; 50(2): 260. CrossRef
Stercoral Colitis
Maxim Saksonov, Gil N. Bachar, Sara Morgenstern, Abdel-Rauf Zeina, Margarita Vasserman, Orith Protnoy, Ofer Benjaminov
Journal of Computer Assisted Tomography.2014; 38(5): 721. CrossRef

Rectal Perforation Caused by Anal Stricture After Hemorrhoid Treatment: Yong Joon Suh, Heon-Kyun Ha, Heung-Kwon Oh, Rumi Shin, Seung-Yong Jeong, Kyu Joo Park; Ann Coloproctol. 2013;29(1):28-30. Published online February 28, 2013; DOI: https://doi.org/10.3393/ac.2013.29.1.28

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Inappropriate therapies for hemorrhoids can lead to various complications including anorectal stricture. We report a patient presenting with catastrophic rectal perforation due to severe anal stricture after inappropriate hemorrhoid treatment. A 67-years old man with perianal pain visited the emergency room. The hemorrhoids accompanied by constipation, had tortured him since his youth. Thus he had undergone injection sclerotherapy several times by an unlicensed therapist and hemorrhoidectomy twice at the clinics of private practitioners. His body temperature was as high as 38.5℃. The computed tomographic scan showed a focal perforation of posterior rectal wall. The emergency operation was performed. The fibrotic tissues of the anal canal were excised. And then a sigmoid loop colostomy was constructed. The patient was discharged four days following the operation. This report calls attention to the enormous risk of unlicensed injection sclerotherapy and overzealous hemorrhoidectomy resulting in scarring, progressive stricture, and eventual rectal perforation.

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The Complications of Hemorrhoidectomy From Patients' Perspective: A Qualitative Study
Masoumeh Ebrahimi Tavani, Yegane Partovi, Tahmineh Poursaki, Farid Gharibi
Health Science Reports.2025;[Epub] CrossRef
Laser hemorrhoidoplasty for hemorrhoidal disease: a systematic review and meta-analysis
Hendry Lie, Evelyn Franca Caesarini, Antonius Agung Purnama, Andry Irawan, Taufik Sudirman, Wifanto Saditya Jeo, Bernardus Parish Budiono, Erik Prabowo, M. Iqbal Rivai, Ryanto Karobuana Sitepu
Lasers in Medical Science.2022; 37(9): 3621. 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

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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

Original Article

Survival Rate and Prognostic Factors in Perforated Colorectal Cancer Patients: A Case-Control Study.: Kim, Min Sang , Lim, Seung Woo , Park, Sung Jin , Gwak, Geumhee , Yang, Keun Ho , Bae, Byung Noe , Kim, Ki Hwan , Han, Sewhan , Kim, Hong Joo , Kim, Young Duck , Kim, Hong Yong; J Korean Soc Coloproctol. 2010;26(1):69-75.; DOI: https://doi.org/10.3393/jksc.2010.26.1.69

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Abstract PDF

PURPOSE
Perforations are rare but serious complications in colorectal cancer. Controversy exists over whether to perform a radical operation because colorectal cancer perforation is considered as an advanced stage disease, and septic complications of peritonitis have been identified as being responsible for a poor prognosis. The aim of this study was to assess the correlation between the survival rate and the clinicopathological parameters that might be used as predictive factors of the prognosis for perforated colorectal cancer.
METHODS
The analysis was based on 24 cases of perforated colorectal cancer (the case group), 48 cases of matching uncomplicated colorectal cancer (the control group), and 72 cases of the case and the control groups combined together (the combined group), all of which were identified during a 10-yr period in a single institution.
RESULTS
The five-year survival rates of the perforated colorectal cancer patients and their matching controls were similar (P=0.484). No significant differences in the locations of the cancer, the pre-operative carcinoembryonic antigen (CEA) levels, the tumor sizes, the resection margins, or the numbers of the lymph nodes harvested were found between the two groups. A univariate analysis of the prognostic factors that influenced the case group revealed that adjuvant chemotherapy (P=0.004) was significantly correlated to a better five-year survival rate. A univariate analysis of the prognostic factors that influenced the five-year survival rate of the combined group revealed that the stage (P<0.001), the pre-op CEA level (P=0.018), the angio invasion (P=0.019), the perineural invasion (P=0.019), the number of harvested lymph nodes (P=0.004), and adjuvant chemotherapy (P=0.001) were significantly correlated to the five-year survival rate. The identified independent prognostic factors in the combined group were the stage (hazard ratio, 5.20), angio-invasion (hazard ratio, 2.81), and adjuvant chemotherapy (hazard ratio, 0.17).
CONCLUSION
The clinical pathway of perforated colorectal cancer is similar to that of uncomplicated colorectal cancer. Therefore, perforated colorectal cancer patients should be recommended for treatment with the appropriate radical operation and adjuvant chemotherapy based on oncologic principles.

Citations

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The Metastatic Lymph Node Ratio is a Crucial Criterion in Colorectal Cancer Therapy Management and Prognosis
Gülçin Harman Kamalı, Sedat Kamalı
European Archives of Medical Research.2022; 38(1): 73. CrossRef
Acute Abdomen in the Oncology Patient
Katrina McGinty
Seminars in Roentgenology.2020; 55(4): 400. CrossRef
Nonobstetrical Acute Abdomen during Pregnancy as a Consequence of Colorectal Carcinoma Perforation: Case Report and Review of the Literature
Žana Žegarac, Željko Duić, Sandra Stasenko
Case Reports in Gastrointestinal Medicine.2019; 2019: 1. CrossRef
Prognostic Value of Perineural Invasion in Colorectal Cancer: A Meta-Analysis
Yuchong Yang, Xuanzhang Huang, Jingxu Sun, Peng Gao, Yongxi Song, Xiaowan Chen, Junhua Zhao, Zhenning Wang
Journal of Gastrointestinal Surgery.2015; 19(6): 1113. CrossRef
Surgical management of obstructed and perforated colorectal cancer: still debating and unresolved issues
Rudra K Maitra, Charles A Maxwell-Armstrong
Colorectal Cancer.2013; 2(6): 573. CrossRef
Multivariate Analysis of the Survival Rate for Treatment Modalities in Incurable Stage IV Colorectal Cancer
Sung Kang Kim, Chang Ho Lee, Min Ro Lee, Jong Hun Kim
Journal of the Korean Society of Coloproctology.2012; 28(1): 35. CrossRef

Case Report

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

Multivariate Analysis of the Risk Factors Associated with Complications and Mortality after and Emergency Operation for Obstructive, Perforated Colorectal Cancer.: Kang, Dong Baek , Shin, Chang Yeol , Lee, Jeong Kyun , Park, Won Cheol; J Korean Soc Coloproctol. 2009;25(3):165-171.; DOI: https://doi.org/10.3393/jksc.2009.25.3.165

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Abstract PDF

PURPOSE
Despite increased effort for the detection of early colorectal cancer, advanced disease presenting as obstruction or perforation still accounts for 8 to 29% and 3-8% of all colorectal cancers, respectively. The aim of this retrospective study was to evaluate the clinical characteristics, the surgical methods, the complications, and the risk factors of obstructive or perforated colorectal cancer that may influence the outcome.
METHODS
A retrospective study was carried out in 60 patients with colorectal cancer, who underwent surgery due to obstruction or perforation from March 2000 to December 2005. The colorectal cancers were considered to be complicated when clinical signs of peritonitis were observed, the radiologic characteristics of the tumor did not permit preoperative mechanical bowel preparation, or perforation existed, when these observations were confirmed by operative findings. The following data were analyzed: clinical characteristics, surgical methods, complications, and risk factors.
RESULTS
Thirty-three patients (55%) had obstruction, and 27 patients (45%) had perforation. Overall, major complications occurred in 33.3% and 48.5%, respectively. The mortality rates were 6.1% and 14.8%, respectively. Risk factors for major complication were age, perforation, and transfusion whereas those for mortality were perforation and American Society of Anesthesiologists (ASA) class.
CONCLUSION
The risk factors of complication were old age, transfusion, and perforation and those for mortality was perforation and ASA class. Earlier diagnosis and prompt, intensive, careful management should be attempted in these high-risk patients.

Citations

Citations to this article as recorded by

Prognostic determinants in surgical critial patients undergoing emergency surgery for Stage III or higher colorectal cancer
Hyun Ho Kim, Sanguk Hwang, Jinbeom Cho
Langenbeck's Archives of Surgery.2025;[Epub] CrossRef
Surgical Outcomes and Risk Factors in Patients Who Underwent Emergency Colorectal Surgery
Dai Sik Jeong, Young Hun Kim, Kyung Jong Kim
Annals of Coloproctology.2017; 33(6): 239. CrossRef
Emergent Colorectal Surgery: What Should Be Considered?
Chang-Nam Kim
Annals of Coloproctology.2016; 32(4): 124. CrossRef
Outcomes and Risk Factors Affecting Mortality in Patients Who Underwent Colorectal Emergency Surgery
Nam Ho Oh, Kyung Jong Kim
Annals of Coloproctology.2016; 32(4): 133. CrossRef
Multivariate Analysis of the Survival Rate for Treatment Modalities in Incurable Stage IV Colorectal Cancer
Sung Kang Kim, Chang Ho Lee, Min Ro Lee, Jong Hun Kim
Journal of the Korean Society of Coloproctology.2012; 28(1): 35. CrossRef

Prognostic Factors for Complication and Mortality of Colonic Perforation.: Park, Keon Hwan , Choi, Pyong Wha , Kim, Jae Il , Noh, Tae Ho , Heo, Tae Gil , Park, Je Hoon , Lee, Myung Soo , Kim, Chul Nam , Chang, Surk Hyo; J Korean Soc Coloproctol. 2009;25(3):143-149.; DOI: https://doi.org/10.3393/jksc.2009.25.3.143

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2 Citations

Abstract PDF

PURPOSE
The present study was performed to assess the outcomes in patients with colonic perforation and to determine the prognostic factors for mortality.
METHODS
The cases of 42 patients who underwent surgery for colonic perforation between March 1999 and September 2008 were retrospectively reviewed. Age, sex, American Society of Anesthesiologists (ASA) classification, presence of preoperative shock, duration of symptoms, cause of perforation, location of perforation, degree of peritonitis, and the Mannheim Peritonitis Index (MPI) score were analyzed for their association with early outcome by using univariate and multivariate analyses.
RESULTS
Diverticulitis (46%, 19 patients) and colorectal cancer (36%, 15 patients) were the most common causes of noniatrogenic colonic perforation, and the sigmoid colon was the most common site of perforation (60%, 25 patients). The postoperative mortality was 21.4% (9 patients). The mortality in patients with preoperative shock, with a MPI score of more than 25, and with Hinchey stage III or IV peritonitis were 70.0%, 57.1%, and 53.3%, respectively (P<0.001). No statistical difference was observed in postoperative mortality with regard to age, sex, ASA classification, duration of symptoms, cause of perforation, and location of perforation. According to the multivariate analysis, preoperative shock proved to be the only significant prognostic factor for mortality (P=0.027) (odds ratio: 19.8, 95% confidence interval: 1.4-276.9).
CONCLUSION
Preoperative shock, a MPI score of more than 25, and Hinchey stage III or IV peritonitis were associated with high postoperative mortality in patients with colonic perforation. Especially, more intensive management and interest are required for patient s with preoperative shock due to colonic perforation.

Citations

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Ostomy in Nontraumatic Conditions: Our Experience and Review of the Literature
Kenan Büyükaşık, Bünyamin Gürbulak, Emre Özoran, Yiğit Düzköylü, Esin Kabul Gürbulak, Aziz Arı, Hasan Bektaş
Indian Journal of Surgery.2016; 78(6): 471. CrossRef
EVALUATION OF MANNHEIM PERITONITIS INDEX (MPI) SCORING SYSTEM IN PROGNOSIS OF PATIENTS WITH PERITONITIS DUE TO HOLLOW VISCOUS PERFORATION
Mahammad Ali Sutar, Ramakrishna Yaradhimmaiah, Nikhath Ingva Arshi
Journal of Evolution of Medical and Dental Sciences.2016; 5(31): 1626. CrossRef

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

Case Report

Rectal Perforation after Anorectal Manometry Following Preoperative Chemoradiotherapy and Low Anterior Resection: Report of a Cases.: Jeong, Woon Kyung , Chung, Tae Sung , Lim, Sang Woo , Park, Ji Won , Lim, Seok Byung , Choi, Hyo Seong , Jeong, Seung Yong; J Korean Soc Coloproctol. 2008;24(4):298-301.; DOI: https://doi.org/10.3393/jksc.2008.24.4.298

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Abstract PDF

Anorectal manometry is widely used to evaluate anorectal function. Few reports have described complications resulting from this procedure. A 47-year-old male underwent preoperative chemoradiotherapy and a low anterior resection for rectal cancer. The patient underwent anorectal manometry at postoperative 8 months. A rectal perforation was diagnosed shortly thereafter. The patient was initially managed conservatively using percutaneous drainage and parenteral antibiotics and then discharged on day 60 after the event. One month later, a colo-cutaneous fistula and expanding abdominal fasciitis developed. The patient underwent surgical exploration, drainage, resection of the rectum including the fistula, and redo-coloanal anastomosis with a diverting ileostomy. The patient discharged without complications on postoperative day 25. Anorectal manometry should be performed with particular care in patients who have undergone radiotherapy and anastomosis at the rectum.

Citations

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Habit training versus habit training with direct visual biofeedback in adults with chronic constipation: study protocol for a randomised controlled trial
Christine Norton, Anton Emmanuel, Natasha Stevens, S. Mark Scott, Ugo Grossi, Sybil Bannister, Sandra Eldridge, James M. Mason, Charles H. Knowles
Trials.2017;[Epub] CrossRef
Colorectal Perforation After Anorectal Manometry for Low Anterior Resection Syndrome
Kyung Ha Lee, Ji Yeon Kim, Young Hoon Sul
Annals of Coloproctology.2017; 33(4): 146. CrossRef
Perforación rectal tras manometría anorrectal sin enfermedad rectal previa: una complicación excepcional resuelta con tratamiento médico
Jorge Antonio Núñez Otero, Mariano Gómez Rubio, Ángel R. Durán Aguado, José L. Martínez Albares
Gastroenterología y Hepatología.2013; 36(9): 577. CrossRef

Original Article

Surgical Management of Colonoscopic Perforations.: Park, Hyoung Chul , Kim, Duck Woo , Kim, Sang Gyun , Park, Kyu Joo , Park, Jae Gahb; J Korean Soc Coloproctol. 2007;23(5):287-291.; DOI: https://doi.org/10.3393/jksc.2007.23.5.287

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Abstract PDF

PURPOSE
The purpose of this study is to evaluate the clinical features that necessitate a temporary stoma for the treatment of colonoscopic perforations.
RESULTS
Between January 2000 and July 2006, 30 patients were treated for colonoscopic perforation. Based on the perforation sites, we classified these patients into the following groups: proximal colon, sigmoid colon, and rectum; we then reviewed clinical data, including the time to operation and management.
RESULTS
Seventeen patients had a perforation during the diagnostic colonoscopy. Of these patients, 14 patients had sigmoid colon perforation. Six underwent an operation within 10 hours after perforation. Of these six, four were managed by primary repair or resection with anastomosis, one sigmoid colon cancer patient by anterior resection, and one rectal cancer patient by low anterior resection with diverting ileostomy. Eight patients underwent more than 12 hours after perforation. Of these eight, three were managed by resection with anastomosis and diverting ileostomy and five by resection with end colostomy. Thirteen patients had a perforation during the therapeutic colonoscopy. Of these patients, 10 patients had a proximal colon perforation. Of these 10, 3 without fever or peritonitis symptom were managed by conservative management, 6 by primary repair or resection with anastomosis, and 1 transverse colon cancer patient by right hemicolectomy. Three patients had sigmoid colon perforation. Of these three, one was managed by primary repair, one by resection with anastomosis, and one sigmoid colon cancer patient by anterior resection.
CONCLUSIONS
The mechanism of perforation, the site of the perforation, and the time to operation are associated with intraperitoneal contamination and have an influence on surgical treatment.

Citations

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A comparative analysis of traditional meat processing methods
Kasun Dissanayake, Mohamed Rifky, Khabibulla Nurmukhamedov, Jasur Makhmayorov, Bakhodir Abdullayev, Jasur Farmanov, Murodjon Samadiy, T. Itao, V. Perskaya, W. Yanmin, D. Morkovkin
E3S Web of Conferences.2024; 494: 04023. 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
Colonoscopic Perforation; A 10-year Experience in Single General Hospital
Ji Eun Oh, Sang Goon Shim
The Korean Journal of Gastroenterology.2009; 54(6): 371. CrossRef
Treatment of Colon Perforation Associated with Colonoscopy
Hae Ran Park, Seong Kyu Baek, Ok Suk Bae, Sung Dae Park
Journal of the Korean Society of Coloproctology.2008; 24(5): 322. CrossRef

Case Report

A Case of Stercoral Perforation of the Sigmoid Colon.: Park, Chan Sup , Cho, Dong Ho , Kim, Hungdai , Han, Won Kon; J Korean Soc Coloproctol. 2006;22(3):197-199.

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Abstract PDF: A stercoral perforation of the colon is a rare phenomenon and is caused by severe prolonged constipation. Since the first reported case in 1894, approximately 80 additional cases have been reported. However, this rare condition seems to have been underestimated because of not only obscure diagnostic standards but also ignorance and failure to notice by surgeons. Due to its high mortality rate of about 35~40%, a stercoral ulcer perforation should be considered in any patient with chronic constipation who presents with peritonitis. We report a case of a 75-year-old female who was diagnosed as having a stercoral perforation of the sigmoid colon and review the clinical features, the diagnosis, and the treatment.

Original Article

Safety of Conservative Treatment of Colonoscopic Perforation.: Na, Eun Jong , Kim, Kyung Jong , Min, Young Don; J Korean Soc Coloproctol. 2005;21(6):384-389.

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9 Download

Abstract PDF: PURPOSE
Colonoscopy is a relatively safe procedure. However, various complications, such as hemorrhage or perforation, can occur, and among them, perforation can lead to death. This study was designed to evaluate the clinical characteristics and the treatment of colonoscopic perforation, as well as the availability of conservative treatment as the initial management.
METHODS
We reviewed the medical records of the 11 patients who had been treated for colonoscopic perforation from May 2003 to April 2005.
RESULTS
Six perforations were related to diagnostic colonoscopy whereas five occurred from therapeutic colonoscopy. The sigmoid colon was the most common perforation site (6 patients), followed by the cecum 2 patients and the transverse colon, splenic flexure, and the rectum 1 patient each. Five patients were diagnosed during colonoscopy. Six patients were diagnosed 12~48 hours after the colonoscopy. Three patients who showed definite signs of peritonitis underwent emergency operations. A conservative treatment was done in eight patients; among them, one patient had an operation on the 3rd. day after the perforation. The remaining seven patients underwent conservative treatment and were followed for up to 1 month without complications. Among these patients, one patient had a recurrent perforation on the 33rd day after the initial perforation, and an operation was done.
CONCLUSIONS
These results suggest that conservative treatment in patients with colon perforations is safe and effective unless there are obvious signs of generalized peritonitis.

Case Reports

Perforation of the Hepatic Flexure of Colon by an Ingested Toothbrush.: Lee, Min Joo , Cho, En Jung , Lee, Min Ro , Kim, Jong Hun , Hwang, Yong; J Korean Soc Coloproctol. 2005;21(5):333-336.

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Abstract PDF: A Foreign body in the gastrointestinal tract is a common clinical problem seen in all age groups and rarely produces symptoms. However, the foreign bodies should be removed if they produce symptoms or remain in the gastrointestinal tract. A 31-year-old man with schizophrenia ingested a 20-cm-sized toothbrush. It passed through the ileocecal valve and penetrated the hepatic flexure of the colon and liver. It was removed successfully by using a surgical procedure. We report this unusual case of colonic perforation by an ingested toothbrush and review the related literature.

Appendicocolic Fistula.: Kim, Min Hoe , Lim, Deok Ho , Kim, Bong Soo , Ku, Jin Hoe , Kang, Haeng Ji , Hwang, Yong Hee , Choi, Kun Phil; J Korean Soc Coloproctol. 2004;20(4):228-230.

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Abstract PDF: An appendicocolic fistula is a rare disease. It seems likely that the appendix becomes adherent to the viscus either before or after its perforation due to appendicitis, so surgeons may become confused when an emergency appendectomy in done. We report one case of an appendicocolic fistula to draw attention to the importance of this fistula and to describe the clinical, the diagnostic, and the therapeutic aspects of the disease.

Ischemic Pseudomembranous Colitis with Perforation due to Polyarteritis Nodosa.: Kim, Ki Nam; J Korean Soc Coloproctol. 2004;20(3):176-179.

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Abstract PDF: Polyarteritis nodosa, one of the necrotizing vasculitis involving predominantly small and medium sized arteries is a rare disease. Gastrointestinal involvements have been reported in more than 50% of patients at some time during its course. The small bowel is the frequent site of involvement in clinically apparent ischemic disease. The colon is less commonly involved, particularly at the initial presentation. We report a rare case of polyarteritis nodosa with ischemic colitis, perforation, and pseudomembrane formation.

Original Articles

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.

The Safety of Intraoperative Colonic Irrigation for Single Stage Procedure in Emergency Based Left Colonic Pathology.: Kim, Bum Ryul , Shon, Dae Ho , Jang, Byung Ik , Jung, Moon Kwan , Shim, Min Chul , Kim, Jae Hwang; J Korean Soc Coloproctol. 2001;17(6):309-315.

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Abstract PDF: Staged procedures are preferred to single stage procedures in emergency based left colonic obstruction or perforation because of the safety. PURPOSE: To evaluate whether the single stage procedure in emergency based left colonic pathology is not safe.
METHODS
We compared medical records of single stage procedure (SP, n=22 male; 10, mean age: 60+/-17, range: 26-82 Yrs) with Hartmanns procedure (HP, n=23 male; 13, mean age: 58+/-16, range: 18-90 Yrs) and diverting loop colostomy (DC, n=19, male; 12, mean age: 59+/-19, range: 19-80 Yrs) in these 4 years. All the patients were admitted via emergency room. Intraoperative colonic irrigation method with newly developed irrigation device (MITech co., Ltd, Seoul, Korea) was used for SP. APACHE III scoring system was applied to evaluate the physiologic status of the patients. Preoperative data were compared with the 1st and 3rd postoperative day (POD).
RESULTS
There were no statistically significant differences in patient demographics and preoperative APACHE III scores. The improvement of APACHE III score was significant in SP and DC on the 3rd POD from 29.6+/-20.9 to 22.9+/-10.2 and 25.7+/-13.3 to 21.4+/-14.8 (P<0.05). There was also a significant improvement in DC (25.7+/-13.3 to 21.9+/-12.9, P<0.05) on the 1st POD, however, there was only a tendency of improvement in SP (29.6+/-20.9 to 26.1+/-12.3) without statistical significance. The scores in HP showed no improvement on the 1st and 3rd POD. There were 3 operative mortalities in HP and one in DC.
CONCLUSIONS
Our results suggest that the safety of the single stage procedure with newly developed colonic irrigation device is comparable to palliative decompressive loop colostomy and better than Hartmanns procedure in emergency based left colonic pathology.

Case Report

Natural Killer (NK) Cell Lymphoma of the Cecum with Perforation:A case of report.: Kim, Ik Yong , Ju, Man Ki , Kim, Jong Seok , Jung, Soon Hee , Kim, Dae Sung , Rhoe, Byoung Seon; J Korean Soc Coloproctol. 2001;17(5):277-282.

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Abstract PDF: Natural Killer cell lymphoma pursued a highly aggressive clinical course, with the aggressiveness and poor prognosis in this biologically distinct primary gastrointestinal lymphoma, a more vigorous systemic therapy should be considered in the addition to surgery. We report an unusual case of aggressive primary Natural Killer cell (NK cell) lymphoma of the cecum. A 38-year old man admitted for intractable fever, diarrhea, and hematochezia. The patient diagnosed as primary NK cell cecal lymphoma with perforation after surgical resection. The primary lesion was deep ulceration with perforation and it revealed metastasis to liver. The immunophenotype of the tumor cell were CD56+, CD3+, UCHL-1+, CD45RO+, polyclonal IGH, TCRr, so confirmed NK cell type lymphoma.

Original Article

Two Cases of Stercoral Perforation of Colon.: Jeong, Keuk Won , Chung, Woo Shik , Chang, Tae Soo; J Korean Soc Coloproctol. 2000;16(2):115-118.

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Abstract PDF: While colon perforation as a complication of diseases such as carcinoma, colitis, diverticular disease, or abdominal trauma is not uncommon, spontaneous perforation of the colon is rare. Although spontaneous perforation is classified as either stercoral or idiopathic on the basis of its etiological background, the pathological mechanisms of the lesions have yet to be determined in detail. Stercoral perforation is a very rare cause of acute abdomen, with fewer than 70 cases documented in the literature; and idiopathic perforation is also infrequently reported. Both disease entities have often been grouped together as idiopathic or spontaneous perforation, resulting in confusion. We report herein two cases of stercoral perforation of the sigmoid colon. The clinical features, diagnosis, and treatment of the disease are reviewed. Surgeons should be aware of the possibility of this fatal disease, despite its rare incidence. Furthermore, it is important to recognize the condition at an early stage of the disease because it has significantly high mortality if surgery is delayed.

Case Report

The Conservative Treatment of Rectal Perforation after Insertion of A Stent and Chemo-Radiotherephy in the Patient with Obstructive Rectal Cancer.: Jung, Jai Hun , Kim, Seog Mo , Kim, Cheong Yong , Ko, Kang Seog; J Korean Soc Coloproctol. 2000;16(1):41-46.

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Abstract PDF: The use of self-expanding metal stent has been widely reported that its utility can make a palliative decompression treatment and one stage operation without doing colostomy in the patient with unresectable and resectable obstructive colorectal cancer, respectively. It, however, can sometimes cause complications such as intestinal perforation. We report that the conservative treantment could be possible without removing stent or performing laparotomy in case of intestinal perforation during chemoradiotheraphy after insert of stent for relieving colonic obstruction in the 53 years old female patient with stage IV rectal cancer.

Original Articles

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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