Annals of Coloproctology

Case Reports

Malignant disease,Rare disease & stoma,Complication

Colonic Perforation After Treatment With Nivolumab in Esophageal Cancer: A Case Report: Hye Jung Cho, Woo Ram Kim, Joo-Hang Kim, Duk Hwan Kim, Dae Jung Kim, Haeyoun Kang; Ann Coloproctol. 2021;37(Suppl 1):S39-S43. Published online June 24, 2021; DOI: https://doi.org/10.3393/ac.2020.00213.0030

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With the advent of checkpoint inhibitors, it has opened up opportunities for numerous cancer patients. However, as is the case with every treatment, complications need to be weighed. Gastrointestinal adverse effects, such as diarrhea and colitis are well-known complications for checkpoint inhibitors. In severe cases, colitis-induced colonic perforation may occur with an estimation of 1.0% to 1.5% in anti-CTLA-4 antibodies. However, only a handful of cases of such devastating complications have been reported in anti-PD-1 antibodies such as pembrolizumab and nivolumab. We here report a case of intestinal perforation in a patient treated with nivolumab.

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Intestinal perforation in recurrent cervical cancer following bevacizumab and pembrolizumab therapy: A case report
Yuanchun Fan, Shihao Liu, Jiangjing Zhao, Yawei Fu, Jiahui Yang, Chunyang Wang, Hui Zhang
Medicine.2025; 104(15): e40473. CrossRef
Chemotherapy-associated pneumoperitoneum in cancer patients: a scoping review
Renee M. Maina, Caroline Rader, Jeevan Kypa, Constantine Asahngwa, Hilary M. Jasmin, Nia N. Zalamea, John S. Nelson, Jonathan L. Altomar, Mary Brinson Owens, Clarisse S. Muenyi, Denis A. Foretia
Annals of Medicine & Surgery.2024; 86(5): 2828. CrossRef
Update on immunotherapy‐mediated colitis: Clinical features, mechanisms, and management
Dandan Wang, Yiwei Zhao, Yiyun Zeng, Lanlin Hu, Chuan Xu
Malignancy Spectrum.2024; 1(4): 225. CrossRef
Gastrointestinal perforation associated with novel antineoplastic agents: A real-world study based on the FDA Adverse Event Reporting System
Zicheng Yu, Haibin Zhu, Hongjun Chen, Lifei Zhu, Xiaolan Liao
Journal of Pharmacy & Pharmaceutical Sciences.2023;[Epub] CrossRef
Gastrointestinal and Hepatobiliary Immune-related Adverse Events: A Histopathologic Review
Zainab I. Alruwaii, Elizabeth A. Montgomery
Advances in Anatomic Pathology.2023; 30(3): 230. CrossRef
An updated review of gastrointestinal toxicity induced by PD-1 inhibitors: from mechanisms to management
Yiyu Cheng, Fangmei Ling, Junrong Li, Yidong Chen, Mingyang Xu, Shuang Li, Liangru Zhu
Frontiers in Immunology.2023;[Epub] CrossRef
Nivolumab

Reactions Weekly.2022; 1892(1): 181. CrossRef
Gastrointestinal and Hepatobiliary Immune-related Adverse Events: A Histopathologic Review
Zainab I. Alruwaii, Elizabeth A. Montgomery
Advances in Anatomic Pathology.2022; 29(4): 183. CrossRef

Benign GI diease

Small Bowel Perforation Associated With Gastrointestinal Graft-Versus-Host Disease and Cytomegalovirus Enteritis in a Patient With Leukemia: A Case Report With Literature Review: Kwang-Seop Song, Min Jung Kim, Han-Ki Lim, Yoon Hwa Hong, Sung Sil Park, Chang Won Hong, Sung Chan Park, Dae Kyung Sohn, Kyung Su Han, Jae Hwan Oh; Ann Coloproctol. 2020;36(4):281-284. Published online August 31, 2020; DOI: https://doi.org/10.3393/ac.2018.10.01.1

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Gastrointestinal graft-versus-host disease (GVHD) is a common complication after hematopoietic stem cell transplantation. Concomitant cytomegalovirus (CMV) enteritis worsens the prognosis of this condition. We report a case of small bowel perforation associated with gastrointestinal GVHD and CMV enteritis in a patient with leukemia who was successfully treated surgically. A 39-year-old man presented with intestinal perforation necessitating emergency surgical intervention. He was diagnosed with T-cell acute lymphoblastic leukemia and developed severe gastrointestinal GVHD and CMV enteritis after hematopoietic stem cell transplantation. His terminal ileum showed a perforation with diffuse wall thinning, and petechiae were observed over long segments of the distal ileum and the proximal colon. Small bowel segmental resection and a subtotal colectomy with a double-barreled ileocolostomy were performed. The patient recovered uneventfully after the operation. Based on reports described in the literature, surgery plays a minor role in the management of gastrointestinal GVHD; however, timely surgical intervention could be effective in selected patients.

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Cytomegalovirus enteritis resistant to antiviral drugs improved following total colectomy
Sae Kawata, Jumpei Takamatsu, Yuichi Yasue, Aya Fukuhara, Jinkoo Kang
Surgical Case Reports.2023;[Epub] CrossRef

Original Article

Benign GI diease

Prognostic Factors and Management for Left Colonic Perforation: Can Hartmann’s Procedure Be Preventable?: Yilseok Joo, Yujin Lee, Taeyoung Yoo, Jungbin Kim, Inseok Park, Geumhee Gwak, Hyunjin Cho, Keunho Yang, Kiwhan Kim, Byung-Noe Bae; Ann Coloproctol. 2020;36(3):178-185. Published online June 30, 2020; DOI: https://doi.org/10.3393/ac.2019.11.14.1

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Abstract PDF

Purpose
To identify factors significantly associated with the mortality of patients with left colonic perforation, and to compare the outcome of Hartmann’s procedure (HP) and primary repair (PR) or primary anastomosis (PA) in patients with left colonic perforation without factors associated with mortality.
Methods
This retrospective study included patients who underwent surgery for left colonic perforation from January 2009 to February 2018. Preoperative factors related to postoperative mortality, including vital signs, laboratory findings, and intraoperative findings, were analyzed by type of operation. The chi-square, Fisher exact, and Mann-Whitney U-tests were used to analyze the data.
Results
Ninety-one patients were included (36 men, 55 women), and 15 (16.5%) died postoperatively. Prognostic factors were age, leukopenia, thrombocytopenia, bleeding tendency, acute kidney injury, hemodynamic instability, and the existence of feculent ascites. Leukopenia and longer operative time were independent risk factors for mortality. Seventy-nine patients did not have leukopenia and 30 of these patients who underwent PR without diversion were excluded from the subanalysis. HP was performed in 30 patients, and PR with diversion and PA with or without diversion were performed in 19. Compared to the other operative methods, HP had no advantage in reducing hospital mortality (P=0.458) and morbidity.
Conclusion
Leukopenia could be an objective prognostic factor for left colonic perforation. Although HP is the gold standard for septic left colonic perforation, it did not improve the hospital mortality of the patients without leukopenia. For such patients, PR or PA may be suggested as an alternative option for left colonic perforation.

Citations

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Risk Factors for Postoperative Major Morbidity, Anastomotic Leakage, Re-Surgery and Mortality in Patients with Colonic Perforation
Maximilian Brunner, Lara Gärtner, Andreas Weiß, Klaus Weber, Axel Denz, Christian Krautz, Georg F. Weber, Robert Grützmann
Journal of Clinical Medicine.2024; 13(17): 5220. CrossRef
Evaluation of Morbidity and Mortality in Iatrogenic Colonic Perforation During Colonoscopy: A Comprehensive Systematic Review and Meta-Analysis
Ajibola A Adebisi, Daniel E Onobun, Adeola Adediran, Reginald N Ononye, Ethel O Ojo, Adedayo Oluyi, Ayotunde Ojo, Stephen Oputa
Cureus.2024;[Epub] CrossRef
Patient outcomes and prognostic factors associated with colonic perforation surgery: a retrospective study
Do-bin Lee, Seonhui Shin, Chun-Seok Yang
Journal of Yeungnam Medical Science.2022; 39(2): 133. CrossRef
Morbidity and Mortality of Neutropenic Patients in Visceral Surgery: A Narrative Review
Ann-Kathrin Lederer, Fabian Bartsch, Markus Moehler, Peter Gaßmann, Hauke Lang
Cells.2022; 11(20): 3314. CrossRef

Case Reports

Benign GI diease,Rare disease & stoma,Complication

Intestinal Perforation as a Paradoxical Reaction to Antitubercular Therapy: A Case Report: Sung Hoon Kang, Hee Seok Moon, Jae Ho Park, Ju Seok Kim, Sun Hyung Kang, Eaum Seok Lee, Seok Hyun Kim, Byung Seok Lee, Jae Kyu Sung, Hyun Yong Jeong, Kyung Ha Lee; Ann Coloproctol. 2021;37(Suppl 1):S18-S23. Published online May 15, 2020; DOI: https://doi.org/10.3393/ac.2020.03.16.1

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Paradoxical reactions to tuberculosis (TB) treatment are characterized by an initial improvement of the clinical symptoms followed by clinical or radiological deterioration of existing tuberculous lesions, or by development of new lesions. Intestinal perforation in gastrointestinal TB can occur as a paradoxical reaction to antitubercular therapy. A 55-year-old man visited the outpatient department with lower abdominal pain and weight loss. He was diagnosed with intestinal TB and started antitubercular therapy. After 3 months of antitubercular therapy, a colonoscopy revealed improvement of the disease. Three days after the colonoscopy, the patient visited the emergency room complaining of abdominal pain. Abdominal computed tomography revealed extraluminal air-filled spaces in the pelvic cavity. We diagnosed a small bowel perforation and performed an emergency laparotomy and a right hemicolectomy with small bowel resection. This report describes the case of intestinal perforation presenting as a paradoxical reaction to antitubercular and provides a brief literature review.

Citations

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Réaction paradoxale tuberculeuse
L.-D. Azoulay, A.-L. Houist, E. Feredj, W. Vindrios, S. Gallien
La Revue de Médecine Interne.2024; 45(5): 279. CrossRef
Left hand abscess as a paradoxical reaction during treatment of disseminated tuberculosis in immunocompetent patient: case report and review of literature
Aisha Alharbi, Aseel Aljahdali, Mohamed Firoze Ahamed, Hassan Almarhabi
BMC Infectious Diseases.2024;[Epub] CrossRef
Paradoxical Reaction to Antitubercular Treatment Causing Colonic Obstruction
Akira Hokama, Yuiko Oishi, Erika Koga, Sayuri Takehara, Jiro Fujita
Chonnam Medical Journal.2022; 58(1): 52. CrossRef
Multiple drugs

Reactions Weekly.2021; 1881(1): 189. CrossRef

Malignant disease, Benign GI diease,Colorectal cancer,Complication

An Unusual Case of Colon Perforation With Multiple Transmural Ulcers After Use of Polmacoxib and Everolimus in a Metastatic Breast Cancer Patient: In-Gyu Song, Kyung Uk Jung, Hyung Ook Kim, Hungdai Kim, Ho-Kyung Chun; Ann Coloproctol. 2021;37(2):120-124. Published online March 16, 2020; DOI: https://doi.org/10.3393/ac.2019.08.17

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Everolimus (Afinitor) is an inhibitor of mammalian target of rapamycin. Polmacoxib (Acelex) is a nonsteroidal anti-inflammatory drug that belongs to the cyclooxygenase-2 (COX-2) inhibitor family and is mainly used for treatment of arthritis. Intestinal perforation has not been reported previously as a complication of everolimus, and perforation of the lower intestinal tract caused by a selective COX-2 inhibitor is extremely rare. We present here a case of colon perforation that occurred after use of polmacoxib in a metastatic breast cancer patient who had been treated with everolimus for the preceding six months.

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Multiple ulcers and perforation of small intestine with everolimus use in a patient with rectal neuroendocrine tumor: A case report
Kentaro Abe, Shigenobu Emoto, Kazuhito Sasaki, Hiroaki Nozawa, Yoichi Yasunaga, Soichiro Ishihara
International Journal of Surgery Case Reports.2023; 106: 108094. CrossRef
Everolimus/polmacoxib

Reactions Weekly.2021; 1869(1): 157. CrossRef

Pneumatic Colorectal Injury Caused by High Pressure Compressed Air: Jin Young Lee, Young Hoon Sul, Seung Je Go, Jin Bong Ye, Jung Hee Choi; Ann Coloproctol. 2019;35(6):357-360. Published online May 22, 2019; DOI: https://doi.org/10.3393/ac.2018.08.19

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The pneumatic colorectal injury caused by high pressure compressed air are rare and can be fatal. Herein, we present a case of 45-year-old male who developed sudden onset of severe abdominal pain after cleaning the dust on his pants with high pressure compressed air gun dust cleaner. Emergent exploratory laparotomy was done which findings are a huge rectal perforation with multiple serosal and subserosal tear in sigmoid to splenic flexure of colon. Anterior resection with left hemicolectomy, and temporary transverse colostomy was performed. Postoperative course was uneventful. Recently, prognosis is generally favorable because of prompt diagnosis and emergent surgical management.

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Laparoscopic Repair of Colorectal Perforations Induced by Compressed Air Pressure: A Case Report
Ibrahim Elnogoomi, Hoorieh Qasemi, Mariam Aylan Alshamsi, Majid Alhammadi, Omar Elnogoomi
Cureus.2024;[Epub] CrossRef
Air Nozzle Injury: Barotrauma Resulted From an Industrial Accident
Ashok N Mhaske, Nishi Gupta, Abhishek Mishra, Shubham Jaiswal, Chirag Dausage, Jyoti Meena, Gourav Goyal
Cureus.2024;[Epub] CrossRef
Emergency laparoscopic resection of the anterior rectum due to rectal trauma secondary to compressed air, case report
Daniel Gómez, Luis F. Cabrera, Mauricio Pedraza, Andres Mendoza-Zuchini, Nicolás Sánchez, Hector W. Cure, Héctor O. Cure Bulicie, Jean A. Pulido
International Journal of Surgery Case Reports.2020; 76: 288. CrossRef

Colonoscopic Removal of an Intrauterine Device That Had Perforated the Rectosigmoid Colon: Jin Myeong Huh, Ki Seok Kim, Yong Seok Cho, Dong Kwon Suh, Jae Uk Lee, Seong Deuk Baek, Sin Kil Moon; Ann Coloproctol. 2018;34(2):106-108. Published online April 30, 2018; DOI: https://doi.org/10.3393/ac.2017.10.30

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The intrauterine device (IUD) is a widely used contraceptive method. One of the most serious and rare complications of using an IUD is colon perforation. We report a case of colonoscopic removal of an IUD that had perforated into the rectosigmoid colon in a 42-year-old woman who presented with no symptoms. Colonoscopy showed that the IUD had penetrated into rectosigmoid colon wall and that an arm of the IUD was embedded in the colon wall. We were able to remove the IUD easily by using colonoscopy. The endoscopic approach may be considered the first choice therapy for selected patients.

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Migrated Foreign Body Perforating the Colon: Scope for Colonoscopy
Aparimita Das, Tarun S Joseph, Gangireddy Siva Sankar Reddy, Amrit Pipara, Sumit Mukhopadhyay
Cureus.2025;[Epub] CrossRef
Retroperitoneal Displacement of an Intrauterine Device (IUD): A Case Report
Godwin Silas Macheku, Fidelis Clarence Jungulu, Ezekiel Kalibugwe Kiyogoma, Kheri Kagya, Salehe Mrutu, Michael Johnson Mahande
International Journal of Innovative Science and Research Technology.2025; : 713. CrossRef
Rectal Foreign Body Shaped Like an Endoscopic Clip: Migrated Intrauterine Devices to the Rectum
Xinyu Xie, BoYuan, Chunmei Li, Lina Cao
Digestive Diseases and Sciences.2025;[Epub] CrossRef
Endoscopic Removal of Intrauterine Contraceptive Device From the Descending Colon: A Case Report
Muhammad Shabbir, Mishal A Aljohani, Abdurahman Alfaiz, Msab Aldakheel, Zeeshan Ali
Cureus.2024;[Epub] CrossRef
Colonoscopic removal of an intrauterine device with rectal perforation: A case report
Lingrun Ye, Yuanyuan Zhu, Fanglai Zhu
Medicine.2024; 103(28): e38872. CrossRef
Is It a “Colon Perforation”? A Case Report and Review of the Literature
Shuangshuang Lu, Xinyu Yao, Jun Shi, Jian Huang, Shaohua Zhuang, Junfang Ma, Yan Liu, Wei Zhang, Lifei Yu, Ping Zhu, Qiuwei Zhu, Ruxia Shi, Hong Zheng, Dong Shao, Yuyan Pan, Shizhen Bao, Li Qin, Lijie Huang, Wenjia Liu, Jin Huang
Frontiers in Medicine.2022;[Epub] CrossRef
Endoscopic removal of an intrauterine device from the lumen of the sigmoid colon
V. V. Bereshchenko, D. V. Lazarevich, N. N. Goncharov, P. V. Khodanovich
Health and Ecology Issues.2022; 19(1): 145. CrossRef
Incomplete Removal of an Intrauterine Device Perforating the Sigmoid Colon
Junseak Lee, Jung Hwan Oh, Jinsu Kim, Chul-Hyun Lim, Sung Hoon Jung
The Korean Journal of Gastroenterology.2021; 78(1): 48. CrossRef
Chronic nodules of sigmoid perforation caused by incarcerated intrauterine contraception device
Xiaohui Huang, Rui Zhong, Liqin Zeng, Xuhui He, Qingshan Deng, Xiuhong Peng, Jieming Li, Xiping Luo
Medicine.2019; 98(4): e14117. CrossRef
Endoscopic Removal of Migrated Intrauterine Device: Case Report and Review of Literature and Technique
Yang Lei, Vadim Iablakov, Riaz J. Karmali, Nauzer Forbes
ACG Case Reports Journal.2019; 6(6): e00090. CrossRef

Original Article

Management Outcomes of Colonoscopic Perforations Are Affected by the General Condition of the Patients: Jae Ho Park, Kyung Jong Kim; Ann Coloproctol. 2018;34(1):16-22. Published online February 28, 2018; DOI: https://doi.org/10.3393/ac.2018.34.1.16

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Abstract PDF

Purpose

The management of a colonoscopic perforation (CP) varies from conservative to surgical. The objective of this study was to evaluate the outcomes between surgical and conservative treatment of patients with a CP.

Methods

From 2003 to 2016, the medical records of patients with CP were retrospectively reviewed. Patients were divided into 2 groups depending on whether they initially received conservative or surgical treatment.

Results

During the study period, a total of 48 patients with a CP were treated. Among them, 5 patients had underlying colorectal cancer and underwent emergency radical cancer surgery; these patients were excluded. The mean age of the remaining 43 patients was 64.5 years old, and the most common perforation site was the sigmoid colon (15 patients). The initial conservative care group included 16 patients, and the surgery group included 27 patients. In the conservative group, 5 patients required conversion to surgery (failure rate: 5 of 16 [31.3%]). Of the surgery group, laparoscopic surgery was performed on 19 patients and open surgery on 8 patients, including 2 conversion cases. Major postoperative complications developed in 11 patients (34.4%), and postoperative mortality developed in 4 patients (12.5%). The only predictor for poor prognosis after surgery was a high American Society of Anesthesiologists physical status classification.

Conclusion

In this study, conservative treatment for patients with a CP had a relatively high failure rate. Furthermore, surgical treatment showed significant rates of complications and mortality, which depended on the general status of the patients.

Citations

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Multicenter retrospective evaluation of ileocecocolic perforations associated with diagnostic lower gastrointestinal endoscopy in dogs and cats
Vanessa L. Woolhead, Jacqueline C. Whittemore, Sarah A. Stewart
Journal of Veterinary Internal Medicine.2020; 34(2): 684. CrossRef

Case Reports

Colorectal Perforation After Anorectal Manometry for Low Anterior Resection Syndrome: Kyung Ha Lee, Ji Yeon Kim, Young Hoon Sul; Ann Coloproctol. 2017;33(4):146-149. Published online August 31, 2017; DOI: https://doi.org/10.3393/ac.2017.33.4.146

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We experienced 3 cases of manometry-induced colon perforation. A 75-year-old man (case 1) underwent anorectal manometry (ARM) 3 years after radiotherapy for prostate cancer and a laparoscopic intersphincteric resection for rectal cancer. A 70-year-old man (case 2) underwent ARM 3 months after conventional neoadjuvant chemoradiotherapy and a laparoscopic low anterior resection for rectal cancer. A 78-year-old man (case 3) underwent ARM 2 months after a laparoscopic intersphincteric resection for rectal cancer. In all cases, a colon perforation with fecal peritonitis occurred. All were treated successfully using prompt and active operations and were discharged without any complications. ARM with a balloon, as a measure of rectal compliance, should be performed 2 months or longer after surgery. If a perforation occurs, prompt and active surgical intervention is necessary due to the high possibility of extensive fecal peritonitis.

Citations

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Effect of low anterior resection syndrome on quality of life in colorectal cancer patients: A retrospective observational study
Dong-Ai Jin, Fang-Ping Gu, Tao-Li Meng, Xuan-Xuan Zhang
World Journal of Gastrointestinal Surgery.2023; 15(10): 2123. CrossRef
Functional anorectal studies in patients with low anterior resection syndrome
Ssu‐Chi Chen, Kaori Futaba, Wing Wa Leung, Cherry Wong, Tony Mak, Simon Ng, Hans Gregersen
Neurogastroenterology & Motility.2022;[Epub] CrossRef
Variation in rectoanal inhibitory reflex after laparoscopic intersphincteric resection for ultralow rectal cancer
Bin Zhang, Ke Zhao, Yu‐Juan Zhao, Shu‐Hui Yin, Guang‐Zuan Zhuo, Yong Zhao, Jian‐Hua Ding
Colorectal Disease.2021; 23(2): 424. CrossRef
Broken beer bottle as a cause of sigmoid perforation: A summary of causes and predictors in the management of traumatic and non-traumatic colorectal perforation
Christian German Ospina-Pérez, Ana Milena Álvarez-Acuña, Lina María López-Álvarez, Rosa María Ospina-Pérez, Ivan David Lozada-Martínez, Sabrina Rahman
International Journal of Surgery Case Reports.2021; 85: 106261. CrossRef
Assessment of defecation function after sphincter-saving resection for mid to low rectal cancer: A cross-sectional study
Bao-Jia Luo, Mei-Chun Zheng, Yang Xia, Zhu Ying, Jian-Hong Peng, Li-Ren Li, Zhi-Zhong Pan, Hui-Ying Qin
European Journal of Oncology Nursing.2021; 55: 102059. CrossRef

Urinary Bladder Injury During Colonoscopy Without Colon Perforation: Jung Wook Suh, Jun Won Min, Hwan Namgung, Dong-Guk Park; Ann Coloproctol. 2017;33(3):112-114. Published online June 30, 2017; DOI: https://doi.org/10.3393/ac.2017.33.3.112

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We report a case of urinary bladder perforation during colonoscopy. A 67-year-old female, who had undergone a transabdominal hysterectomy for uterine myomas 15 years ago, visited the emergency department with complaint of abdominal pain after a screening colonoscopy. Laparoscopic examination revealed severe adhesion between the sigmoid colon and the urinary bladder. The urinary bladder wall was weakened, and several perforation sites were found. The surgery was converted to a laparotomy. After a thorough examination, we performed primary repair for the perforation sites, followed by an omentopexy.

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Trauma to the solid abdominal organs: The missed dark box of colonoscopy
Mohamed H Emara, Usama Mazid, Yasmine A Elshaer, Mahmoud A Elkerdawy, Dilaver Farooq Malik, Aya M Mahros
World Journal of Gastroenterology.2024; 30(7): 624. CrossRef
Mesenteric laceration of the sigmoid colon after colonoscopy: A rare complication
Min Wu, Yonghua Lin, Zhichao Chen, Jianfeng Wei
Asian Journal of Surgery.2023; 46(11): 5391. CrossRef
Massive retroperitoneal hematoma following colonoscopy
Reo Ohtsuka, Hodaka Amano, Kei Niida, Takeaki Yoshino, Michiyo Owari, Ryotaro Takano, Yuichi Akama, Yohei Watanabe, Toshiyasu Iwao
Medicine.2018; 97(31): e11723. CrossRef

Colonic Perforation Secondary to Idiopathic Intramural Hemorrhage: Takashi Sakamoto, Akira Saito, Alan Kawarai Lefor, Tadao Kubota; Ann Coloproctol. 2016;32(6):239-242. Published online December 31, 2016; DOI: https://doi.org/10.3393/ac.2016.32.6.239

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Abstract PDF

Intramural colonic hemorrhage is rare and often secondary to trauma or anticoagulation therapy. Idiopathic intramural hemorrhages in the alimentary tract have rarely been reported. While several reports of spontaneous perforation of an intramural rectal hematoma have been published, no reports of spontaneous perforation in the ascending colon due to a hematoma have. We describe a patient with an ascending colonic perforation secondary to spontaneous intramural hemorrhage. The patient is a 35-year-old male, who presented with acute abdominal pain and no history of trauma. An abdominal computed tomography scan showed a high-density area around the ascending colon, and nonoperative management was instituted. On the eighth hospital day, the pain worsened, and abdominal computed tomography scan showed free air. An emergent right hemicolectomy was performed. Intramural hematoma and ischemia with perforation, with no obvious etiology, were found. The patient was discharged on the 14th postoperative day.

Citations

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A case of gastrointestinal perforation following transarterial embolization for an intramural hematoma after cold snare polypectomy of an adenoma in the transverse colon
Yuu Kodama, Yuji Mizokami, Yuzo Toyama, Hiroyasu Kusaka, Gen Maeda, Shingo Asahara, Ryuji Nagahama, Shin‐ichiro Horiguchi, Hiroki Aoyama
DEN Open.2025;[Epub] CrossRef
Giant Proximal Right Colon Submucosal Hematoma Leading to a Large Bowel Obstruction
Arham Siddiqui, Hijab Ahmed, Muhammad H Nazim, Basem Soliman, Izi Obokhare
Cureus.2022;[Epub] CrossRef
Spontaneous colonic perforation in adults: Evaluation of a pooled case series
Ren Chongxi, Ji Jinggang, Shi Yan, Wang Hongqiao, Liu Yan, Yang Fengshuo
Science Progress.2020;[Epub] CrossRef
Idiopathic intramural hematoma of the right colon. A case report and review of the literature
Rosario Vecchio, Emma Cacciola, Michele Figuera, Renato Catalano, Giuseppe Giulla, Emanuele Rosario Distefano, Eva Intagliata
International Journal of Surgery Case Reports.2019; 60: 16. CrossRef
Intramural Hematoma Causing Hematochezia After Colonoscopy With Polypectomy
Aleksandar Gavrić, Rok Dežman, Sebastian Stefanović, Jan Drnovšek, Borut Štabuc
ACG Case Reports Journal.2019; 6(7): e00129. CrossRef

Pneumoretroperitoneum, Pneumomediastinum, Subcutaneous Emphysema After a Rectal Endoscopic Mucosal Resection: Hee Cheul Jung, Hyun Jin Kim, Sung Bok Ji, Jun Hyeong Cho, Ji Hye Kwak, Chang Min Lee, Wan Soo Kim, Jin Ju Kim, Jae Min Lee, Sang Su Lee; Ann Coloproctol. 2016;32(6):234-238. Published online December 31, 2016; DOI: https://doi.org/10.3393/ac.2016.32.6.234

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Abstract PDF

An endoscopic mucosal resection (EMR) is an effective and safe therapeutic technique for treating a patient with a laterally-spreading tumor (LST). Colonoscopic-procedure-related complications are noted to be about 2.8% worldwide, and a perforation is the most common. Most colon perforations cause pneumoperitoneum. However, a perforation within the retroperitoneal portion of the colon (rectum and some of sigmoid colon) may cause an extraperitoneal perforation, and the leaking free air may induce pneumoretroperitoneum, pneumomediastinum, and subcutaneous emphysema, depending on the amount of discharged air. Herein, we present the case of a patient with an extraperitoneal colon microperforation which manifested as pneumoretroperitoneum, pneumomediastinum, and subcutaneous emphysema after an EMR for a sigmoid LST, which was successfully treated with medical treatment and endoscopic clipping.

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Asymptomatic sigmoid diverticulum perforation-induced subcutaneous, mediastinal, and retroperitoneal emphysema: A case report and literature review
Daichi Setoguchi, Naoki Iwanaga, Kotaro Nema, Tomoya Hagiwara, Kotaro Hayashida, Koki Yamashita, Tatsuro Hirayama, Masataka Yoshida, Kazuaki Takeda, Shotaro Ide, Masato Tashiro, Takahiro Takazono, Masachika Kitajima, Noriho Sakamoto, Koichi Izumikawa, Kat
Respiratory Medicine Case Reports.2025; 56: 102229. CrossRef
The Close Relationship between Large Bowel and Heart: When a Colonic Perforation Mimics an Acute Myocardial Infarction
Maria Francesca Secchi, Carlo Torre, Giovanni Dui, Francesco Virdis, Mauro Podda
Case Reports in Surgery.2018; 2018: 1. CrossRef
Pneumoretroperitoneum, Pneumomediastinum, Pneumothorax, and Subcutaneous Emphysema after Diagnostic Colonoscopy
Hee Sung Lee, Hwan Hee Park, Ju Seok Kim, Sun Hyung Kang, Hee Seok Moon, Jae Kyu Sung, Byung Seok Lee, Hyun Yong Jeong
The Korean Journal of Gastroenterology.2017; 70(3): 145. CrossRef

Original Articles

Predictors of Morbidity and Mortality After Surgery for Intestinal Perforation: Rumi Shin, Sang Mok Lee, Beonghoon Sohn, Dong Woon Lee, Inho Song, Young Jun Chai, Hae Won Lee, Hye Seong Ahn, In Mok Jung, Jung Kee Chung, Seung Chul Heo; Ann Coloproctol. 2016;32(6):221-227. Published online December 31, 2016; DOI: https://doi.org/10.3393/ac.2016.32.6.221

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Abstract PDF

Purpose

An intestinal perforation is a rare condition, but has a high mortality rate, even after immediate surgical intervention. The clinical predictors of postoperative morbidity and mortality are still not well established, so this study attempted to identify risk factors for postoperative morbidity and mortality after surgery for an intestinal perforation.

Methods

We retrospectively analyzed the cases of 117 patients who underwent surgery for an intestinal perforation at a single institution in Korea from November 2008 to June 2014. Factors related with postoperative mortality at 1 month and other postoperative complications were investigated.

Results

The mean age of enrolled patients was 66.0 ± 15.8 years and 66% of the patients were male. Fifteen patients (13%) died within 1 month after surgical treatment. Univariate analysis indicated that patient-related factors associated with mortality were low systolic and diastolic blood pressure, low serum albumin, low serum protein, low total cholesterol, and high blood urea nitrogen; the surgery-related factor associated with mortality was feculent ascites. Multivariate analysis using a logistic regression indicated that low systolic blood pressure and feculent ascites independently increased the risk for mortality; postoperative complications were more likely in both females and those with low estimated glomerular filtration rates and elevated serum C-reactive protein levels.

Conclusion

Various factors were associated with postoperative clinical outcomes of patients with an intestinal perforation. Morbidity and mortality following an intestinal perforation were greater in patients with unstable initial vital signs, poor nutritional status, and feculent ascites.

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The Outcomes of Management for Colonoscopic Perforation: A 12-Year Experience at a Single Institute: Jung Yun Park, Pyong Wha Choi, Sung Min Jung, Nam-Hoon Kim; Ann Coloproctol. 2016;32(5):175-183. Published online October 31, 2016; DOI: https://doi.org/10.3393/ac.2016.32.5.175

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Abstract PDF

Purpose

Optimal management of colonoscopic perforation (CP) is controversial because early diagnosis and prompt management play critical roles in morbidity and mortality. Herein, we evaluate the outcomes and clinical characteristics of patients with CP according to treatment modality to help establish guidelines for managing CP.

Methods

Our retrospective analysis included 40 CP patients from January 1, 2003, to December 31, 2014. Patients with CP were categorized into 2 groups according to therapeutic modality: operation (surgery) and nonoperation (endo-luminal clip application or conservative treatment) groups.

Results

The postoperative morbidity rate was 40%, and no mortalities were noted. The incidence of abdominal pain and tenderness in patients who received only conservative management was significantly lower than in those who underwent surgery (P < 0.001 and P = 0.004, respectively). Patients tended to undergo surgery more often for diagnosis times longer than 24 hours and for diagnostic CPs. The mean hospital stays for the operation and nonoperation groups were 14.6 ± 7.77 and 5.9 ± 1.62 days, respectively (P < 0.001). Compared to the operation group, the nonoperation group began intake of liquid diets significantly earlier after perforation (3.8 ± 1.32 days vs. 5.6 ± 1.25 days, P < 0.001) and used antibiotics for a shorter duration (4.7 ± 1.29 days vs. 8.7 ± 2.23 days, P < 0.001).

Conclusion

The time of diagnosis and the injury mechanism may be useful indications for conservative management. Nonoperative management, such as endo-luminal clip application, might be beneficial, when feasible, for the treatment of patients with CP.

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Jae Ho Park, Kyung Jong Kim
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Case Report

Proper Management for Morbid Iatrogenic Retroperitoneal Barium Insufflation: Jalal Vahedian-Ardakani, Shahram Nazerani, Amir Saraee, Ali Sarmast, Ehsan Saraee, Mohammad Reza Keramati; Ann Coloproctol. 2014;30(6):285-289. Published online December 31, 2014; DOI: https://doi.org/10.3393/ac.2014.30.6.285

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41 Download
2 Web of Science
3 Citations

Abstract PDF

A barium enema is a diagnostic and therapeutic procedure commonly used for colon and rectum problems. Rectal perforation with extensive intra- and/or extraperitoneal spillage of barium is a devastating complication of a barium enema that leads to a significant increase in patient mortality. Due to the low number of reported cases in recent scientific literature and the lack of experience with the management of these cases, we would like to present our treatment approach to a rare case of retroperitoneal contamination with barium, followed by its intraperitoneal involvement during a diagnostic barium enema. Our experience with long-term management of the patient and the good outcome will be depicted in this paper.

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