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Primary perforations of the sigmoid colon and rectum

, : Primary perforations of the sigmoid colon and rectum. Gazzetta Medica Italiana Archivio per le Scienze Mediche 145(12): 727-732

A series of 5 cases of primary perforations of the sigmoid colon and rectum observed over a 6 year period is reported. These intestinal perforations are definitely not attributable to any specific pathological process identified during surgery or, in the survivors, during post-operative clinical, radiological and endoscopic studies. All the patients were hospitalised and given emergency surgery on the sudden onset of peritonitis. Surgery revealed an oval or wavy perforation 5-20 mm in diameter and necrotic at the edges either in the peritoneal rectum or on the antimesocolic sigmoid colon. Treatment consisted of the exteriorisation or suturing of the perforation and colostomy upstream on the sigmoid colon or on the transverse colon. Two patients died in the post-operative period. The three survivors presented no recurrences or symptoms attributable to the large intestine. Endoscopic rays performed prior to closure of the colostomy 2-5 months later and 1-5 years after the occurrence seem to reveal a complete cure. Attention is drawn to a rare but not exceptional pathology that is consequently exposed to the risk of erroneous differential diagnosis.

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