A STORY OF EXTRAORDİNARY ABDOMİNALLY PERFORATİTON

Öz

Pneumoperitoneum is the result of a gastrointestinal (GI) tract perforation in more than 90% of cases. Perforation of the stomach or duodenum caused by peptic ulcer is considered the most common cause of pneumoperitoneum. In this article, we present a case of pneumoperitoneum associated with sigmoid colon perforation, which is the result of the patient trying to create a laxative effect by inserting the hose attached to the wash basin into his rectum and opening the water afterwards. An 89 years old male patient was brought to the emergency department with complaints of abdominal pain starting about 2 hours ago. The patient's abdominal ultrasonography showed free fluid up to 10 cm in the lower abdomen. Posterior anterior chest X-ray and direct standing abdominal X-ray of the patient had subdiaphragmatic free air and images with free fluid, pneumoperitoneum and perforation were obtained in contrast enhanced abdominal tomography. As a result of surgery performed by general surgery it was seen approximately 30 cm proximal from the rectumthat there was a 4 cm perforation in the sigmoid colon. We must consider pneumoperitoneum, which is the result of colon perforation especially in elderly patients with acute abdominal pain, to be definitely among our differential diagnoses.

Anahtar Kelimeler

• Sigmoid colon perforation
• pneumoperitoneum
• acute abdomen

Kaynakça

1. 1-Mularski RA, Ciccolo ML, Rappaport WD. Nonsurgical causes of pneumoperitoneum.West J Med 1999; 170: 41-46.
2. 2-Harari D, Gurwitz JH, Avorn J, et al. Constipation: assessment and management in an institutionalized elderly population. J Am Geriatr Soc. 1994; 42: 947-952
3. 3-Harari D, Gurwitz JH, Minaker KL. Constipation in the elderly. J Am Geriatr Soc. 1993; 41: 1130-40
4. 4-Paran H, Butnaru G, Neufeld D, et al. Enema-induced perforation of the rectum in chronically constipated patients. Dis Colon Rectum 1999; 42: 1609-1612
5. 5-Gedebou TM, Wong RA, Rappaport WD, et al. Clinical presentation and management of iatrogenic colonperforations. Am J Surg 1996; 172: 454-458
6. 6-Suh HH, Kim YJ, Kim SK. Colorectal injury by compressed air - a report of two cases. J Korean Med Sci1996; 11: 179-82.