A Case Series Characterizing the Spectrum of Colonic Perforation: A Retrospective Study From a Tertiary Care Center in Central India

TL;DR

This study examines 15 cases of colonic perforation in Central India, highlighting the importance of early diagnosis and tailored surgical treatment for better patient outcomes.

Contribution

The study provides a detailed case series from a Central Indian tertiary center, emphasizing the spectrum and management of colonic perforation in a resource-limited setting.

Findings

The transverse colon was the most common site of perforation, followed by the sigmoid and descending colon.

Iatrogenic and colonoscopy-related causes were identified among the etiologies, alongside infectious and inflammatory factors.

Surgical strategies included Hartmann’s procedure, primary repair, and repair with stoma, based on contamination and patient stability.

Abstract

Background

Colonic perforation is a rare but life-threatening surgical emergency with a broad spectrum of etiologies and presentations. This retrospective case series from a tertiary care center in Central India analyzes 15 consecutive cases to describe patient demographics, clinical features, diagnostic findings, perforation sites, etiologies (including iatrogenic and colonoscopy-related), management strategies, and outcomes, with an emphasis on early recognition and tailored surgical intervention.

Methodology

This retrospective, observational study included adults with confirmed colonic perforation treated between January 2022 and March 2025 at a tertiary care hospital in Central India. Data collection encompassed demographics, clinical presentation, duration of symptoms, diagnostic workup (imaging modalities, including X-ray and CT, and colonoscopy when available), perforation characteristics (site, suspected etiology, etc.), intraoperative findings, and definitive surgical management and its outcomes. Descriptive statistics were employed to summarize patterns and outcomes, with particular attention to associations among perforation site, cause, and chosen surgical strategy.

Results

The cohort showed a female predominance of 9/15 (60%), with 60% aged 60 years or older. All patients presented with abdominal pain; tenderness was universal, 15/15 (100%), with abdominal rigidity in 86.6% (13/15) and peritoneal signs in most cases. Pneumoperitoneum was detected on imaging in all patients, 15/15 (100%). The transverse colon was the most frequently involved site, 8/15 (53.3%), followed by the sigmoid, 3/15 (20%), and descending colon, 2/15 (13.3%). Etiologies included iatrogenic, colonoscopy-related perforations, as well as infectious, inflammatory, and spontaneous causes. Imaging consistently demonstrated pneumoperitoneum, with CT and X-ray aiding localization and planning. All patients underwent surgery, with management strategies including Hartmann’s procedure, 6/15 (40%), primary repair, 5/15 (33.3%), and primary repair with diverting stoma, 3/15 (20%), decisions guided by the degree of contamination and patient stability. The outcomes underscore the importance of prompt surgical intervention and individualized decision-making to optimize results in this setting.

Conclusions

Early recognition and meticulous, patient-specific surgical management are essential for favorable outcomes in colonic perforation. The transverse and sigmoid colon emerged as common sites, reflecting anatomical vulnerabilities and procedure-related risks in this cohort. Cross-sectional imaging facilitates rapid localization and planning, enabling appropriate selection among primary repair, diversion, or resection with stoma. This study reinforces the value of a multidisciplinary, tailored approach to reduce morbidity and mortality associated with colonic perforation in resource-limited, high-volume centers, emphasizing the potential for improved survival through timely, evidence-informed clinical decisions.

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