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Colonic Perforation

A life-threatening surgical emergency caused by full-thickness rupture of the colon wall requiring urgent intervention.

Written by: Saygı Hospital Health Guide Editorial Board
Last updated:

This content has been compiled by the Saygı Hospital Health Guide Editorial Board and is periodically reviewed by a specialist physician.

This content is for informational purposes only and does not constitute medical advice. You can book an appointment at our Genel Cerrahi department. Book Appointment →

What is Colonic Perforation?

Colonic perforation is a full-thickness rupture of the colon wall through which bacteria and fecal contents escape into the peritoneal cavity. The main causes include diverticulitis complications, colon cancer, ischemic colitis, foreign bodies, and iatrogenic perforation (colonoscopy).

Free air and fecal contents spread within the abdominal cavity, leading to generalized peritonitis. Free peritoneal perforation represents the most severe form, while contained perforation manifests with localized abscess.

Early mortality is high; the Hinchey classification (for diverticular perforation) guides the choice of treatment. Hartmann's procedure is the most commonly preferred surgical approach in emergency settings.

Symptoms

Sudden onset of board-like rigid widespread abdominal pain
Fever, tachycardia, hypotension (signs of septic shock)
Marked guarding and rebound tenderness
Nausea, vomiting, and decreased bowel sounds
Free subdiaphragmatic air on upright chest X-ray
Leukocytosis, elevated CRP, metabolic acidosis

Risk Factors

Acute diverticulitis (most common cause)
Advanced colon cancer
Ischemic colitis and mesenteric ischemia
Iatrogenic perforation during colonoscopy
Foreign body and trauma
Long-term corticosteroid use

When to See a Doctor?

If you experience any of the following symptoms, seek medical attention promptly:

  • Sudden onset of board-like abdomen and diffuse tenderness require emergency department admission
  • Abdominal pain accompanied by fever and tachycardia
  • Worsening pain in a patient with known diverticulitis
  • Abdominal pain and distension after colonoscopy
  • Fecal incontinence with perianal pain and fever

Treatment Methods

01
Emergency imaging: upright chest X-ray, contrast-enhanced CT (for perforation site and extent)
02
Resuscitation in intensive care: large IV access, fluids, broad-spectrum antibiotics
03
Hartmann's procedure: colon resection, colostomy, and Hartmann's pouch (emergency standard)
04
Primary anastomosis with or without protective ileostomy: in selected stable patients with limited contamination
05
Percutaneous drainage: in selected Hinchey Stage III cases (localized purulent peritonitis)
06
Stoma reversal surgery 3-6 months after Hartmann's procedure

Which Department to Visit?

You can visit our Genel Cerrahi department for these complaints. Our specialist physicians will create the most suitable treatment plan for you.

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Health Disclaimer: The information on this page is prepared for general informational purposes only. It does not replace medical diagnosis and treatment. Please consult your physician for your complaints. Saygı Hospital does not accept responsibility for actions taken based on the information on this page.