Perforation of the Colon in Large Bowel Obstruction Due to Carcinoma*

Summary Free perforation of the obstructed colon due to carcinoma has, not without reason; a sinister reputation. With the aid of modern methods of resuscitation and antibiotics, recovery from this catastrophe is possible. In order to ascertain the results of various methods of surgical management 34 cases were surveyed. Untreated, the condition is uniformly fatal. Simple drainage is little better than no treatment; the only patient surviving had only minimal contamination of the peritoneum. The addition of colostomy or caecostomy to the procedure of drainage was uniformly unsuccessful. It is suggested that the reason for this is that continued infection of the peritoneum occurs from bowel severely damaged by distension and ischaemia. The logical conclusion from the cases reviewed is that the perforated bowel should be exteriorized or excised. Where these procedures were carried out the results wert obviously better. It is suggested that, for various reasons, excision of the devitalized bowel is preferable to simple exteriorization. Review of the literature indicates that other authors have reached similar conclusions.