[Surgical methods in non-traumatic perforations of the colon into the free peritoneum (36 cases)]

When operating as an emergency for a perforation of the colon should one carry out a by-pass operation, colostomy or restore intestinal continuity? 36 colonic perforations are reported here, as a complication of cancer in 50 p. 100 of cases, or sigmoiditis in 38 p. 100 of cases. The perforation was situated on the sigmoid in 77 p. 100 of cases. 13 by-pass operations were carried out with a 23 p. 100 mortality, 12 colectomies without anastomosis with a 50 p. 100 mortality, and 2 colectomies with restoration of continuity, 9 p. 100 mortality. The overall mortality was 27.7 p. 100 much less than reported by other authors but, nevertheless partly due to the severity of peritonitis due to the presence of feces and, partly due to the operation adopted. The present attitude of the authors depends on the merits of each case. A large incision is made and the peritoneum thoroughly cleaned. If the surgeon is experienced, colonic resection is advisable for perforated cnacer and certain cases of sigmoiditis. Restoration of continuity depends, above all, on the anatomical condition of the colon above the lesion. Hartmann's resections or by-pass operations thus still have indications.