A Case of Self-Induced Hydrostatic Colonic Perforation

Area of Science:

• Gastroenterology
• Colorectal Surgery

Background:

• Constipation is highly prevalent in the elderly due to factors like medication, immobility, and diminished defecatory urges.
• Elderly patients often present with comorbidities such as dementia or psychiatric disorders, complicating management.
• Colonic perforation due to hydrostatic pressure is uncommon, typically linked to fluoroscopic procedures.

Observation:

• A 95-year-old male presented with acute surgical abdomen and sepsis.
• He had a history of chronic constipation and self-administered enemas using a rubber hose.
• Sigmoid colon perforation was discovered during emergency surgery, alongside pre-existing diverticular disease.

Findings:

• The patient underwent a Hartmann's procedure following abdominal lavage.
• Despite surgical intervention, the patient succumbed to multi-organ failure two days post-operation.
• This case illustrates a rare instance of self-induced hydrostatic colonic perforation.

Implications:

• Self-induced hydrostatic colonic perforation is an exceedingly rare and often fatal complication.
• Delayed presentation and advanced age significantly worsen the prognosis.
• This case underscores the critical need for patient education regarding safe constipation management practices.