Acute colonic perforation

• Management depends on cause
• Neoplastic
  • Obstructing
    • Cecum most likely to perforated
      • In the patient who is found to have a perforated caecum as a result of an obstructing distal cancer, an extended right hemicolectomy or subtotal colectomy is the treatment of choice.
    • Whether or not an anastomosis is fashioned will depend on the degree of peritoneal contamination.
  • Perforated cancer
    • For the cancer that has perforated primarily, it is important to resect the lesion itself to eliminate not only the malignancy but also the source of sepsis.
• Benign
  • Diverticula
  • Intestinal ischemia
  • Volvulus
  • Post colonoscopy
  • Iatrogenic

Principles

• Stable - consider anastomosis - patient and disease factors
• Unstable - stoma or damage control surgery (Laparostomy)