#Hepatic flexture of colon free#

Histologic examination of the specimen revealed no evidence of inflammatory bowel disease, no signs of ischemia or necrosis, the broken ends of the muscle are regular with non-specific changes in the mucosa (Figures 3-5). The patient expired day 4 post operation form multi-organ dysfunction. After a thorough lavage, a right hemicolectomy and ileo-transverse anastomosis was performed. No diverticulae, signs of ischemia or necrosis, foreign bodies, palpable masses or hard fecal matter was noted.

#Hepatic flexture of colon free#

Intra-operative findings included: feculent peritonitis with approximately 1.0 L of free fluid, an approximately 2 cm perforation in the proximal transverse colon a few cm distal to the hepatic flexure on the anti-mesenteric border (Figure 2). Laboratory results revealed: WBC: 12.5, Hemoglobin: 12.6, Platelet: 159, Cr: 2.3, BUN: 45, electrolytes: within normal limits, ABG: anion gap metabolic acidosis, Abdominal X-ray revealed a pneumoperitoneum and pancreatic calcification (Figure 1).įollowing adequate resuscitation, the patient underwent an exploratory laparotomy. The remaining physical exam was unremarkable. Abdominal examination revealed generalized tenderness with board like rigidity, guarding and rebound tenderness. BP: 134/68 mmHg, P: 105, regular, respiratory rate: 20 breaths/min with the remaining vitals within normal limits. Examination revealed an ill looking, malnourished female in moderate painful distress. Of note, she has a 36 pack year smoking history and drinks 3 nips (30ml = 1 nip) of puncheon rum (no less than 75% of alcohol by volume) daily for many years. Her surgical history was unremarkable with her drug history revealing oral hypoglycemic use with no ASA or NSAID use. The pain was described as 10/10 severity, constant, non-radiating, aggravated by movement with relief on lying still. Case descriptionĪ 50 year old female who is a known diabetic presented to our institution with a sudden onset severe abdominal which became generalized with a duration of 6 hours. We report a case of a 50 year old female who presented to us with colonic perforation without an identifiable cause. As a result, it is a diagnosis of exclusion and can only be made after exhaustion of all other possible causes. It is defined as perforation of the colon without identifiable etiology. Idiopathic perforation of the colon, also referred to as spontaneous colonic perforation is an extremely rare disease in both adults and neonates. Idiopathic colonic perforation, adult Introduction Mortality of this disease is secondary to the resulting fecal peritonitis and can be reduced by early recognition and timely surgical intervention.

Due to its rarity, it is difficult to establish causality between the disease and associated patient factors. As the name suggests, there is no identifiable cause making this a diagnosis of exclusion. True idiopathic perforation of the colon in the adult is both a rare and unusual clinical entity.