Abstrakt
Patients and Method: In the course of the recent 18 years, a total of 137 patients with perforated colon were treated at the Department of Surgery of the Charles University Hospital in Prague 10. All patients with perforation suffered from peritonitis.
Perforations accounted for 3% of patients operated on during the same time period at our Clinic for some sort of colon lesions. The most frequent primary pathology to which the perforation could be attributed was either neoplasia (54) or diverticulitis (51) and less frequent were artificial injury (23), ischemic lesion (seven) and ulceration (two).
All patients underwent surgery after a short preparatory phase. Results: 44 of our patients died with an average survival time of 6.6 days and their mean age was 75 years.
Among all treated subjects, 85 patients experienced some sort of complications. Conclusions: We wish to emphasize that the ultimate decision on the surgical procedure is taken after laparotomy and must weigh several factors such as the extent and duration of peritonitis, character of the causal pathological lesion and its localization, age and the overall physical condition of each individual patient.
As far as the circumstances permit, the principal aim of the surgical treatment is to remove the source of infection together with the primary pathological lesion. Preferable are one-stage resection procedures with anastomosis or Hartmann's procedure.
It is obvious that local findings and the general state of the patients often contraindicate a radical surgery, and one must resort to a derivative procedure and drainage, or possibly suture. Such operations are of course fraught with a high mortality rate.