Sigmoid perforation
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WSES guidelines colonic perforation diverticulitis perforation management
Sigmoid perforation is a hole in the sigmoid colon that allows bowel contents and bacteria to enter the abdomen. It is a surgical emergency, especially if there is free air, peritonitis, sepsis, or shock.
Seek emergency care immediately for severe or worsening lower abdominal pain, rigid or distended abdomen, fever, vomiting, inability to pass stool/gas, fainting, confusion, rapid heart rate, or low blood pressure.
Common causes
- Perforated sigmoid diverticulitis
- Colon cancer with obstruction or perforation
- Iatrogenic injury, such as after colonoscopy
- Trauma
- Ischemic colitis
- Stercoral perforation from severe fecal impaction
Initial hospital management
- Resuscitation: IV fluids, oxygen as needed, analgesia, blood tests, lactate, cultures if septic
- Nil by mouth and broad-spectrum IV antibiotics covering enteric gram-negative organisms and anaerobes
- Urgent contrast CT abdomen/pelvis when the patient is stable enough
- Early surgical and anesthesia review, with sepsis/source-control management
Definitive treatment
Treatment depends on contamination, cause, bowel viability, and patient stability:
- Contained microperforation / localized abscess: selected stable patients may be treated with antibiotics, bowel rest, and possibly CT-guided drainage.
- Free perforation or generalized peritonitis: urgent operation for source control, usually resection of the diseased sigmoid segment.
- In stable, suitable patients, surgeons may perform resection with primary anastomosis, sometimes with a protective ileostomy.
- In unstable patients, fecal peritonitis, major comorbidity, or poor tissue condition, Hartmann procedure is often used: sigmoid resection, end colostomy, and closure of the rectal stump. Textbook guidance cautions that simply closing an inflamed colonic perforation is prone to breakdown; the affected segment generally requires resection. The WSES diverticulitis guidance similarly favors resection and anastomosis with or without diversion in stable patients, and Hartmann procedure in unstable or high-risk patients.
If this refers to a CT report or an actual patient, share the exact wording, clinical status, and cause if known. But do not delay emergency surgical assessment.
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