A perforated colon can occur as a result of disease or certain medical procedures.
According to the National Institutes of Health, perforated colon symptoms may initially consist of intense abdominal pain that worsens by movement, as well as vomiting, nausea, chills and fever. A perforated colon is a hole that goes completely through the wall of the colon and is a medical emergency that may require surgery. It can also be life threatening if the contents of the colon are released inside the abdominal cavity. Diseases of the colon, such as diverticulosis, appendicitis, Crohn's disease and ulcerative colitis, most commonly cause a perforated colon; however, certain medical procedures also put a patient at risk for a perforation.
Diverticulosis occurs when tiny pockets called diverticula develop in the wall of the colon. They are believed to be caused by the simultaneous contraction of two or more of the muscular bands surrounding the colon. The contents of the colon become trapped, press against the wall of the colon and create the diverticula.
Diverticulosis is the most common condition of the colon and affects half of all Americans to some extent by the age of 80, according to Johns Hopkins Medicine. Diverticulosis rarely produces significant symptoms, but complications may develop in as many as 20 percent of cases. In severe cases, the diverticula become infected and the colon may even become perforated. The initial symptom of a perforated colon due to diverticulosis is usually intense pain immediately after pressing on the abdomen, known as "rebound" tenderness. Symptoms such as extremely low blood pressure and shock can mean that the infection from the perforated diverticulum has spread throughout the lining of the abdomen in a condition known as peritonitis.
The appendix is a fingerlike appendage of the cecum (a part of the colon). It is a vestigial organ that serves no known function in modern humans, but it can become infected and inflamed. Acute appendicitis can progress until the appendix wall begins to break down in a condition known as perforated appendicitis. This can develop into an abscess, which may result in peritonitis. According to the University of Michigan Health System, about 20 percent of appendicitis cases do not produce symptoms until the appendix is perforated.
The initial symptoms of appendicitis are usually pain and tenderness, although the specifics are variable. The classic presentation is pain in the lower right quadrant of the abdomen that originates near the navel and migrates to the lower right side of the abdomen between the navel and hip. These symptoms typically become more severe and localized over the next 12 to 24 hours and may be more noticeable when coughing or moving. The abdominal pain may be accompanied by loss of appetite, mild fever, nausea, vomiting and a mildly elevated white blood cell count. In less characteristic cases, the abdomen may be less tender or the pain may originate in a different area.
Crohn's disease is a condition in which the digestive tract's lining becomes inflamed and often spreads deeper into the walls of the affected digestive tract. It commonly causes abdominal pain accompanied by severe diarrhea and can be debilitating. The early stages of Crohn's disease are characterized by small, isolated sores on the intestine's surface, which can develop into large ulcers that may penetrate or even perforate the intestinal wall. Chronic inflammation can lead to ulcers anywhere in the digestive tract, including the colon. A perforated colon due to Crohn's disease can be a life-threatening complication.
Ulcerative colitis is similar to Crohn's disease in that it is an inflammatory bowel disease characterized by chronic inflammation. However, unlike Crohn's disease, ulcerative colitis occurs primarily in the innermost lining of the colon and rectum. It only affects continuous areas of the colon and often spreads into the layers of the intestinal wall. A perforated colon is also a possible complication of ulcerative colitis.
The symptoms of ulcerative colitis depend on the location and severity of the inflammation. The inflammation in left-sided colitis extends from the rectum into the sigmoid and descending colon. The symptoms of this form of colitis include abdominal cramping and pain, bloody diarrhea and weight loss. Pancolitis can affect the entire colon and cause similar symptoms in addition to fatigue and night sweats. Fulminant colitis also affects the entire colon and is a rare, life-threatening form of ulcerative colitis. In addition to severe abdominal pain and profuse diarrhea, fulminant colitis may occasionally cause dehydration and shock. Fulminant colitis also carries the highest risk of serious complications, such as a perforated colon.
There are also medical procedures that involve inserting a tube into the rectum, which can perforate the colon on very rare occasions. A barium enema may be performed to diagnose colon cancer and the extent of inflammatory bowel disease. The enema is used to fill the colon with barium sulfate, which serves as a contrast medium for a series of X-rays. A colonoscopy uses a small camera on the end of a flexible tube to examine the colon for a variety of conditions, including colorectal cancer, unexplained blood in the stool and polyps. The colonoscope is advanced to the lowest part of the small bowel and air is inserted to provide a better view. A colon perforation occurs in less than 1 out of 1,000 colonoscopies. A sigmoidoscopy is similar to a colonoscopy, but only examines the lower third of the colon.
A perforated colon can allow the intestinal contents to leak into the abdominal cavity and cause inflammation of a thin membrane, called the peritoneum, which lines this cavity. This condition is called secondary peritonitis when the inflammation is due to bacteria from the digestive tract. Possible symptoms of peritonitis include:
According to the University of Maryland Medical Center, secondary peritonitis has a 10 to 40 percent fatality rate, with a higher incidence in the elderly or patients with symptoms longer than 48 hours or a compromised immune system.