TITLE:
Pathophysiological analysis and strategy for stercoral perforation of the colon
AUTHORS:
Koichi Sato, Hiroshi Maekawa, Mutsumi Sakurada, Hajime Orita, Tomoaki Ito, Yoshihiro Komatsu, Fumiko Hirata, Ryo Wada
KEYWORDS:
Stercoral Perforation of the Colon; APACHE-II Score; SOFA Score; Polymyxin B Immobilized Fiber (PMX-DHP)
JOURNAL NAME:
Open Journal of Gastroenterology,
Vol.2 No.2,
March
30,
2012
ABSTRACT: Perpose: In order to establish the pathophysiological features and strategy for stercoral perforation of the colon, we herein analyze a series of stercoral perforation of the colon. Method: Ten patients were diagnosed with stercoral perforation. Clinical features, primary diseases, triggers, causative bacteria in ascites, postoperative complications, pathological features, severity of the disease, and effect of direct hemoperfusion with polymyxin B immobilized fiber (PMX-DHP) were investigated. Results: Nine patients had a long history of serious and chronic constipation and 7 patients had hypertension. Causative bacteria in ascites during the operation were most commonly Escherichia coli. There were a lot of severe postoperative complications such as sepsis, disseminated intravascular coagulation, and acute lung injury. With regard to the microscopic findings of the perforation site, the intestinal wall showed severe nonspecific inflammatory changes, including an increase of mono-nuclear cells in the lamina propria. There were 4 hospital deaths, so the mortality rate was 40%. APACHE- II and SOFA score were high postoperation and 24 hours after the operation. PMX-DHP was performed in 8 cases of severe conditions of stercoral perforation of the colon. Because the catecholamine index improved within 24 hours, four of 8 cases were rescued. Conclusion: Most of the patients with stercoral perforation of the colon had severe postoperative complications. The severity of the disease was extremely high, therefore, early diagnosis based on pathophy-siological features and comprehensive therapies including PMX-DHP were necessary for strategy of treating stercoral perforation of the colon.