Idiopathic colonic perforation in the neonate

Spontaneous colonic perforation in adults: Evaluation of a pooled case series

Spontaneous colonic perforation in adults (SCPA) is rare but important. Its clinicopathological features and outcomes remain unclear. Therefore, the aim of the current study was to explore and investigate the clinicopathological characteristics, clinical outcomes and potential risk factors for patients with SCPA. Data of seven patients with SCPA treated in our hospitals from January 2008 to December 2017, and 221 cases from research databases before 2018 were retrospectively analyzed. The description of SCPA included stercoral perforation of the colon (SPC), idiopathic perforation of the colon (IPC) and spontaneous colonic perforation (SCP) in the study. All SCPA patients presented with unexplained abdominal pain and peritonitis. The median age was 62.5 years. The definite diagnosis preoperatively was 20.6%. The commonest lesion location was sigmoid colon and Hartmann's operation accounted for 59.3%. Histopathology of stercoral perforation (HSP) and histopathology of idiopathic perforation (HIP) were two histopathological findings. Postoperative complication was 67.7% and mortality was 31.1%. Univariate and multivariate analyses showed that chronic constipation was an independent risk factor for histopathological features (p ≤ 0.001, p = 0.005). Age of patients was associated with both postoperative complication (p = 0.012, p = 0.044) and mortality (p = 0.013, p = 0.034). Univariate analysis showed that HSP was associated with postoperative complication (p = 0.015). Our findings from the analysis pertaining to SCPA confirm those from previous studies, supporting the SCPA, as a uniform description, is an infrequent and life-threatening disease requiring early surgical intervention. We found that the elderly with chronic constipation was a high-risk category and those with HIP had a more favorable outcome than that of patients with HSP.

Idiopathic neonatal colonic perforation- a case report

Perforation of the transverse colon in neonate is a rare finding in clinical practice. We report a case of Idiopathic neonatal colonic perforation in a twenty-one days old, healthy, female neonate without any demonstrable cause. She presented with abdominal distention and constipation. Abdominal radiograph showed massive pneumoperitoneum. On exploration, transverse colonic perforation was found near splenic flexure area. The perforation was closed primarily. Other than inflammatory fibrin flakes the rest of the large intestine and small bowel appeared normal. Hirschsprung's diseases, necrotizing enterocolitis, small left colon syndrome, atresia, imperforate anus, cystic fibrosis are some causes of colonic perforation in neonates. However none of the clinical features or intra-operative finding of the above conditions could be found in our case. At follow-up, the baby showed normal weight gain without any symptoms.