LUOGuo-de , CAOYong-kuan , ZHANGLin , ZHANGGuo-hu , WANGPei-hong , GONGJia-qing
  • Department of Gastrointestinal Surgery, Center of General Surgery, Chengdu Military General Hospital, Chengdu, Sichuan 610083, P. R. China;
Non-tumor; Back wall of ascending colon; Perforation
10.7507/1002-0179.20140568
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Objective To explore the early diagnosis and treatment of acute non-tumor perforation of the back wall of ascending colon. Methods We retrospectively analyzed the clinical data of 17 patients with acute non-tumor perforation of the back wall of ascending colon treated between July 2007 and April 2014 in our hospital. Among them, 8 patients who underwent perforation repair combined with abdominal cavity drainage were regarded as the experimental group, and the other 9 patients who underwent operation of right hemicolectomy (or ascending colon resection) were designated as the control group. Clinical indexes and biochemical indexes of both the two groups were compared and analyzed. Results All patients were cured. The operation time[(74.20±12.45), (120.23±15.20) minutes; t=-3.224, P<0.001], the intraoperative blood loss[(40.24±12.20), (80.69±18.98) mL; t=-4.114, P<0.001], the postoperative anal exhaust[(75.62±6.56), (84.54±7.82) hours; t=1.108, P=0.037], the medical expenses[(18.2±5.7) thousand yuan, (26.5±8.3) thousand yuan; t=-5.556, P<0.001], and the hypersensitive C-reaction protein on the third day after operation[(89.45±8.98), (99.85±10.78) mg/L; t=-3.004, P=0.029] in the experimental group and the control group all had significant differences. There was no significant difference between the two groups in the hospital stay time[(9.80±3.16), (9.81±3.20) days; t=1.501, P=0.080]. There was one case of incision infection in the experimental group and one case of fat liquefaction of incision in the control group, and both of them were cured after treatment. Conclusion The early abdominal sign of perforation of the back wall of ascending colon is not obvious, which can easily lead to misdiagnosis as acute appendicitis. Early diagnosis mainly depends on the clinical symptom, vital sign, blood routine examination and CT examination. Among them, CT findings of gaseous sign behind peritoneum is a definite diagnosis, and operation should be arranged as early as possible. Perforation repair combined with abdominal cavity drainage is preferred due to its advantages of being simple, saving time, less bleeding and lighter traumatic reaction.

Citation： LUOGuo-de, CAOYong-kuan, ZHANGLin, ZHANGGuo-hu, WANGPei-hong, GONGJia-qing. Diagnosis and Treatment of Acute Non-tumor Perforation of the Back Wall of Ascending Colon. West China Medical Journal, 2014, 29(10): 1879-1882. doi: 10.7507/1002-0179.20140568 Copy

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