Clinical characteristics of the idiopathic perforation of the colon.

BACKGROUND AND GOALS: Idiopathic perforation of the colon (IPC) is an extremely rare disease, the pathogenesis of which remains poorly understood. We investigate the clinical characteristics of IPC to help improve the diagnosis and treatment of this rare condition. STUDY: We performed a retrospective evaluation of 16 IPC cases diagnosed from 1999 to 2009 which included clinical findings, laboratory data, treatment procedure, and outcome. RESULTS: The most common site of colon perforation was the sigmoid colon (56.3%) followed by the transverse colon (25%). The median age of the IPC patient group was 72.5 years (range: 50 to 86 y) and the mortality rate for the IPC patient group was 18.8%. Eleven patients (68.8%) had a history of chronic constipation. Creatine phosphokinase (CPK) levels were significantly higher in the survivor group than the deceased group (182 U/L vs. 50 U/L; P=0.024), and CPK levels were higher in patients with constipation than in those without constipation (187 U/L vs. 46 U/L; P=0.024). Computed tomography images showed either free air or a dirty mass that indicated extraluminal feces in all cases. The median size of a perforation was 2.0 cm (range: 0.5 to 8.0 cm). Fourteen patients had resection of the perforation segment and colostomy and 2 of these patients had resection without diverting colostomy. CONCLUSIONS: IPC most commonly occurs in the sigmoid colon of elderly people who have chronic constipation. Although chronic constipation is correlated with high CPK levels, other factors, such as poor nutrition status or a delay in treatment, may be associated with an increased mortality rate in IPC patients.

Primary gastric small cell carcinoma: report of a case and review of the literature.

A 52-year-old man suffering from a pure-type primary gastric small cell carcinoma was treated with surgery and combination chemotherapy. The small cell carcinoma, approximately 6.5 cm in diameter, was situated in the posterior wall of the antrum and there were no distant metastases. Total gastrectomy and regional lymph node dissection was carried out. Histological examination revealed a solid pattern of proliferation of small cells with hyperchromatic, round nuclei and scant cytoplasm. Neoplastic cells infiltrated into the subserosal layer with severe lymphatic and vascular invasion. Regional lymph node cells were mostly replaced by tumor cells that stained positive for Grimelius, neuron-specific enolase (NSE), and synaptophysin. Accumulations of electron-dense core granules in the small neoplastic cells were seen by electron microscopy. Following surgery, the patient was treated with adjuvant chemotherapy consisting of cisplatin and etoposide. The patient is alive and recurrence free 3 years after surgical operation. We review 107 published cases of primary gastric small cell carcinoma, an extremely rare disease first reported in 1976. Small cell carcinoma is an aggressive, malignant tumor. Intensive chemotherapy is essential for patient survival even when curative surgical resection is carried out.