Overview
Sigmoid colon perforation is a surgical emergency characterized by a breach in the colonic wall of the sigmoid segment, often leading to peritonitis. It can result from various causes, including diverticulitis, malignancy, and, less commonly, foreign body ingestion 1.Diagnosis
Clinical Presentation: Abdominal pain, distension, and signs of peritonism 1.
Laboratory Tests: Elevated inflammatory markers (e.g., CRP, WBC) 1.
Imaging: CT scan revealing a linear density projecting through the colonic wall 1.Management
Surgical Intervention: Emergency laparotomy with procedures such as Hartmann's procedure (resection with end colostomy) 1.
Source Removal: Identification and removal of the causative foreign body (e.g., chicken bone) 1.Special Populations
Foreign Body Ingestion: Uncommon cause in pediatrics and elderly, but possible in all age groups 1.Key Recommendations
Prompt Surgical Exploration: Initiate emergency laparotomy upon suspicion of sigmoid colon perforation to prevent sepsis 1 (Evidence: Strong).
Identify and Remove Foreign Body: During surgery, meticulously search for and remove any foreign objects contributing to perforation 1 (Evidence: Strong).
Consider Hartmann's Procedure: For definitive management, Hartmann's procedure may be indicated to manage the perforation and subsequent complications 1 (Evidence: Moderate).References
1 Boland PA, Quidwai ST, Mitru R, McCarthy E, Aremu M. Sigmoid Perforation Secondary to Accidental Ingestion of a Chicken Bone. Irish medical journal 2020. link