ĐẶC ĐIỂM LÂM SÀNG VÀ KẾT QUẢ PHẪU THUẬT THỦNG ĐẠI TRÀNG TỰ PHÁT: CA LÂM SÀNG HIẾM GẶP VÀ ĐIỂM LẠI Y VĂN

Abstract

Study aim: 1. The clinical and paraclinical feature of spontaneous Perfogation of Colon and surgical result. 2. Review of literature. Patient and method: Retrospective study, Case report (rare diseases). Result: -Male patient, aged of 57 years old. - Medical history: 2022 he was diagnosed  cancer of oesophage and had chemio-radiated therapy. + 2023: Cancer of amydal PT2N0M0 (histophathology: SCC) and had surgery. +4/2024: Recidive of oesophageal cancer and had gastrostomy for feeding. - Urgent hospitalization for  left upper quadrant pain that radiated all abdomen with fever more than 24h. - On physical examination: The abdomen was rigid with generalized tenderness. - Temperature was 38ºC, pulse rate was 95/min, blood pressure 120/90 mmhg -A plain film of the abdomen showed free gas under right dome of diaphragm. - Abdominal  ultrasound revealed free liquid in lower left quadrant of abdomen. - Laboratory findings: + Red blood cell counts: 4,27 T/L; Hb:112 g/L, white bood cell counts: 17,36 G/L, Platelete: 184 G/L. + Biochemistry: Creatinin 72 mmol/L; Ure 5,2 mmol/L; GOT 12,4 U/L; GPT 17,5U/l. - Urgent operation: At laparotomy, there was 0,5 cm perfogaton on the anti-mesenteric border of lower left colon with copious amount of purulent fluid in the peritoneum anđ in the pelvis. Suture of perforation and exteriorization of left sutured colon (the left colon was brought to exterior part of anterior abdominal wall to prevent collection of leaked fluid in the peritoneal cavity). - The patient recovered unvenfullly and was discharged on the 8th post operative day. - Pathological report revealed edema of mucosa, chronic inflammatory tissue. Conclusion: Spontaneous colonic perforgation is rare diasease which happened in over 60 years old patient. The sex ratio was male/female: 2/1. More than 50% of  lesions located in recto - sigmoid junction and sigmoid colon. There were 68% up to more than 80% of patients had constipation. The positive preoperation  diagnosis of colon perforgation was low (around 9,5 to 20,6%). Abdominal CTScan seem to be  the effective method to diagnose. Early diagnosis and surgical management were the important factor to reduce the mortality and complication. The stercoral perforgation  was  worse pronostic than the idiopathic one.