[As lumbago treated, delayed diagnosis of large intestine perforation with extremely severe peritonitis--case report with focus on the value of diagnostic laparoscopy].

We report on a colon perforation with peritonitis which remained clinically undetected until the 4th day post trauma although the patient suffered from lumbalgia-like symptoms. He then developed an acute abdomen with sudden onset, being caused by a sigmoidal rupture and a consecutive diffuse peritonitis. A colon resection was performed according to the Hartmann procedure. Almost 36 revisions were necessary due to necrosis and perforation. Having treated the peritonitis successfully it was possible to close the abdomen and to remove the stomata. The case is discussed in relation to standard diagnostic procedures while a special interest is focused on the usage of sonography, explorative laparoscopy and laparotomy. We finally introduce the algorithm being applied to similar cases at our trauma center.