Stercoraceous and idiopathic perforations of the colon

Fourteen patients have been encountered with stercoraceous or idiopathic perforations of the colon. Seven patients had a stercoraceous perforation; four had an idiopathic perforation; and three patients remained without exact classification. All the patients were admitted to hospital because of sudden abdominal pain. All except one patient, who was in an agonal condition, were operated on with a diagnosis of peritonitis. The preoperative clinical, radiologic and laboratory examinations were not specific, and in only one instance, the provisional diagnosis was correct. The main differnece between idiopathic and stercoraceous perforations was the macroscopic and histologic appearance of the perforation. In a perforated stercoraceous ulcer, the perforation was a round or an ovoid hole with necrotic and inflammatory edges, while in the idiopathic form, the perforation was a tear with a normal appearance of the colonic wall. The treatment consisted of a closure of the perforation and a proximally situated stoma, or exteriorization. Four patients of the seven with stercoraceous perforations survived. In idiopathic perforations, the prognosis was poor. All patients died during the first 24 hours after the operation. This possibly is an indication of some basic difference in the pathophysiology of these two diseases.