A small tear in the colon, a colon perforation can be quite serious. Colon and rectal surgeon Nasrin Ghalyaie, MD, an independent member of the HonorHealth medical staff, discusses how this condition can occur and how it’s treated.
Q. What can cause spontaneous colon perforation and how common is it?
A: Colonic perforation can happen in the setting of acute diverticulitis. Diverticulitis is inflammation or infection (or both) in a balloon-like pouch called a diverticulum in the intestine.
It’s estimated that 10 percent of Americans over age 40 and about half over age 60 have diverticulosis — one or more pouches in the intestine where there is not yet inflammation or infection. Low dietary fiber, chronic constipation, increased age, obesity and lack of physical activity are important risk factors for development of diverticulosis. Of all patients with diverticulosis, 10-25 percent will become symptomatic (acute diverticulitis).
When you have acute diverticulitis, a perforated colon is not that unusual because diverticulitis causes tiny tears — perforations — in the colon walls. These tears can grow larger and become problematic.
Colonic perforation can also be a life-threatening complication of recent colon surgery called anastomotic leakage. That’s when tissue that was surgically joined develops a leak. Other causes are uncontrolled ulcerative colitis or Crohn’s disease and certain ulcers associated with fecal impaction, another relatively uncommon condition where stool gets stuck in the colon or rectum.
Q. What are the signs and symptoms of a colon perforation?
A: They can include indications of sepsis, a severe infection within the body:
- Worsening abdominal pain or tenderness
- Fever and chills
- Very low body temperature
- Decreased urination
- Rapid pulse
- Rapid breathing
- Nausea or vomiting
- Patches of discolored skin
- Changes in mental ability
- Problems breathing
Sepsis can be fatal. If you have more than three or four of these symptoms at one time — especially if you’ve been recently diagnosed with acute diverticulitis or you’ve recently had colon surgery — seek medical attention immediately.
Q. How is colon perforation treated?
A: Contained perforation — where the contents of the colon have not leaked into the abdominal cavity because of the tear — can be treated in most cases with percutaneous drainage and intravenous antibiotics. The tear may repair itself once the infection is cleared up.
"Free" perforation, where contents of the colon spill into the abdominal cavity, requires emergency surgery in which the diseased segment of colon is removed.