Surgery, Gastroenterology and Oncology

Background Aim: Spontaneous perforation of the sigmoid colon is defined as a sudden perforation of the normal colon in the absence of diseases. However, its etiology remains unclear.

Methods: Between January 2010 and December 2017, twenty-three patients who underwent Hartmann's operative procedure with colostomy for acute peritonitis due to sudden perforation of the sigmoid colon at our hospital were enrolled in this study. Patients were divided into two groups according to the cause of the perforation (i.e., spontaneous perforation in seven and diverticulosis in sixteen).

Results: All patients had a long history of chronic constipation. The mean age of the spontaneous group was 79.0 (71-87) years, which was significantly older than that of the diverticulosis group. Significant differences in gender, complication rates, or nutritional factors, such as body mass index, serum total protein, albumin, and cholinesterase, were not identified between the two groups. Although the lymphocyte counts of the spontaneous group were significantly lower than those of the diverticulosis group (p=0.029), significant differences were not identified in the neutrophil-to-lymphocyte ratio between the two groups.
The diameters of the perforations in the spontaneous group were significantly larger than that of the diverticulosis group (p=0.046).

Conclusion: Spontaneous perforation of the sigmoid colon due to chronic constipation may not be due to undernutrition but instead due to immune depression.

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