Acute perforation of the colon.

Acute perforation of the colon causes fecal peritonitis, which is associated with high rates of morbidity and mortality. Findings in 78 patients with perforation of the colon showed that the commonest causative condition was diverticulitis (in 42%) and that the commonest site was the sigmoid colon (in 65%). The overall mortality in this series was 49%, most of the deaths being due to peritonitis; the extent of anatomic spread of peritonitis was a major factor. The form of treatment was also a factor in mortality: mortality was lowest in patients treated by diversionary colostomy (only 38%) and highest in those treated by exteriorization of perforation (71%) and in those not treated operatively (71%). With respect to postoperative complications in patients who underwent operation, wound infection and pulmonary abnormalities each occurred in 50%. This review suggests that current methods of management of patients with perforation of the colon are less than satisfactory.