대한대장항문학회

Purpose : To evaluate factors that predict prognosis of colon perforation, we review the<br>hospital records of 37 patients who underwent emergency operation for colon perforation.<br>Methods : Information of clinical findings, Acute Physiology and Chronic Health Evaluation<br>(APACHE II score), perforation sites and causes, operation methods, and postoperative<br>complications were obtained. Results : The causes of perforation were traumatic 11 (29.7%),<br>iatrogenic 10 (27.0%), diverticular 6 (16.2%), cancerous process 6 (16.2%), strangulated hernia<br>2 (5.4%), ischemic colitis 1 (2.7%) and stercoral 1 (2.7%). The longer duration from colon<br>perforation to operation, the more severe intra-abdominal fecal contamination was seen. The<br>complication rate was increased as the intra-abdominal fecal contamination increased or<br>APACHE II score increased (p＜0.05). But there were no correlation between the complication<br>rate and perforation sites and causes. In according to operative managements, one-stage<br>operation (simple closure or resection with anastomosis) group had more lower complication<br>rate than two-stage operation (formation of colostomy) group, unexpectedly (31.3% vs. 52.4%,<br>p＞0.05). Also former group had lower complication rate compared to latter group in left colon<br>(40% vs 50%). Conclusions : The factors that predict of mortality and morbidity are not<br>perforation site, causes, and operation method, but preoperative physiologic status (APACHE<br>II score) and intra-abdominal fecal contamination. So preoperative proper and vigorous<br>treatment for improvement of physiologic status and shortening of interval to operation are<br>important for better results. And primary closure and resection with anastomosis is useful for<br>colon perforation in selected circumstance regardless of its site and cause.<br>