Original communication| Volume 18, ISSUE 5, P547-555, November 1945

Observations on large bowel perforations

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      • 1.
        1. Experiences with large bowel perforations are analyzed.
      • 2.
        2. Nineteen autopsies were recorded over a ten-year period. Perforation associated with diverticulitis accounted for ten of these deaths, seven were due to malignancy, and the remaining two to perforation by mechanical agents within the lumen.
      • 3.
        3. Four recent autopsies in which large bowel perforations were revealed are cited critically and in detail, and a clinicopathologic survey is made in each instance.
      • 4.
        4. The morbidity and mortality in diverticulitis complicated by perforation are distressingly high.
      • 5.
        5. Probably between 10 and 20 per cent of primary large bowel malignancies first come to medical attention with the complication of perforation. The prognosis is extremely grave in this group.
      • 6.
        6. Two unusual cases of perforation of the sigmoid due to intraluminal insult are recorded: one was due to perforation of an impacted fowl bone in a patient who gave no history of ingestion of the foreign body. The second case was one of rupture of a rectosigmoid following a vigorously administered enema; the lower sigmoid was anatomically sharply angulated as a result of an old operative procedure.
      • 7.
        7. Treatment of perforation of the large bowel from any cause is essentially the same: early and generous drainage with a minimum of manipulation of the site of penetration and a proximal decompressive colostomy are the indicated surgical measures.
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