# Non-surgical Management of Colon Perforation Due to Recurrence of Colon Cancer With Extraluminal Feces in a Patient With Massive Peritoneal Adhesions

## TL;DR

An elderly patient with colon cancer and severe abdominal adhesions survived colon perforation without surgery for 174 days using conservative treatment.

## Contribution

This case suggests non-surgical management may be viable in select patients with peritoneal adhesions and colon perforation.

## Key findings

- The patient survived colon perforation with extraluminal feces without surgery for 174 days.
- Conservative treatment included antibiotics, morphine, and close monitoring.
- Peritoneal adhesions may limit the spread of infection, enabling non-operative success.

## Abstract

Colon perforation with fecal peritonitis is usually fatal without prompt surgical intervention. We report the case of an 89-year-old woman with colon perforation and extraluminal feces who survived for 174 days without surgery in the presence of extensive postoperative peritoneal adhesions. The patient had previously undergone two abdominal surgeries for colorectal cancer, resulting in severe intra-abdominal adhesions. Despite radiological evidence of intraperitoneal free air and extraluminal feces, she was managed conservatively with antibiotics, morphine hydrochloride, supportive care, and close monitoring. This case suggests that, in carefully selected patients with marked peritoneal adhesions, non-operative management may warrant reconsideration as a potential therapeutic option for colon perforation before deeming that the condition is inoperable.