A Case of Systemic Sclerosis with Perforation of the Transverse Colon.

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  • 横行結腸穿孔をきたした全身性硬化症の１例

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Abstract

A 61-year-old woman who had been followed up for systemic sclerosis came to our hospital complaining of severe upper abdominal pain and constipation that had persisted for about two months. An abdominal CT scan revealed intra-abdominal free air, and emergency laparotomy was performed for a diagnosis of gastrointestinal perforation. Three bulges (wide-mouthed diverticuli) were found on the antimesenteric border of the transverse colon, and the colon was perforated proximal to the site of these diverticuli. Feces had escaped through the perforation into the omental bursa, and partial resection of the transverse colon and a colostomy were performed. The wide-mouthed diverticuli which are pathognomonic of SSc, contained hard round fecal masses, and fecal impaction was thought to be a cause of the intestinal obstruction and perforation. Hypoperistalsis seems to have been related to the formation of hard round feces. The patient's postoperative course was uneventful, and she was discharged on the 25th day. Colorectal perforation is rare, but important because of its seriousness. Evaluation of gastrointestinal manifestations and maintaining regular bowel movements are mandatory during clinical treatment of patients with this disease.

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