Spontaneous perforation of the colon.

We describe the clinical presentation and surgical and pathologic findings in seven cases of spontaneous perforation of the colon. The dominant categories found were (1) rupture, usually of the cecum, associated with paralytic ileus, and (2) an idiopathic variety, invariably at the sigmoid. Though the onset of cecal rupture in paralytic ileus is insidious and may be anticipated, that of the idiopathic is not. If the clinical triad of sudden urge to defecate, hematochezia, and peritonitis occurs in a previously asymptomatic individual, idiopathic colonic rupture should be ruled out. An abdominal roentgenogram showing free intraperitoneal air strongly confirms the diagnosis. Prompt surgical repair of the rupture usually leads to recovery.