A Case of Segmental Absence of Intestinal Musculature Causing Colonic Perforation

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  • YONEMURA Keisuke
    Department of Surgery, Japan Self Defense Forces Sapporo Hospital Department of Surgery, National Defense Medical College
  • KONDO Nobuhiko
    Department of Surgery, Japan Self Defense Forces Sapporo Hospital
  • MATSUZAKI Junichi
    Department of Surgery, Japan Self Defense Forces Sapporo Hospital
  • ITO Nozomi
    Department of Surgery, Japan Self Defense Forces Sapporo Hospital
  • HORI Tatsuhiko
    Department of Surgery, Japan Self Defense Forces Sapporo Hospital
  • TORIGOE Toshihiko
    Department of Pathology 1, Sapporo Medical University School of Medicine

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Other Title
  • 結腸穿孔を生じたsegmental absence of intestinal musculatureの1例
  • 症例 結腸穿孔を生じたsegmental absence of intestinal musculatureの1例
  • ショウレイ ケッチョウ センコウ オ ショウジタ segmental absence of intestinal musculature ノ 1レイ

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Abstract

Segmental absence of intestinal musculature (SAIM) is a rare entity involving partial absence of the intestinal muscularis propria. It is known as a cause of intestinal obstruction or perforation in neonates, but it is very rare in adults. A 54-year-old man, who had no significant medical history, presented to our hospital with abdominal pain and signs of peritonitis which occurred following defecation on the third day after gastrography and still persisted. When he was first seen, he had high fever (38°C) and there were tenderness and rebound tenderness in the entire abdomen. Blood analysis revealed increased inflammatory reaction. An abdominal computed tomography scan showed free air under the diaphragm and near the descending colon. Emergency laparotomy performed with a diagnosis of perforative peritonitis showed a perforation in the descending colon. Partial resection of the colon involving the perforation site, abdominal drainage and colostomy were performed. Pathological examination of the resected colon showed SAIM. It is inferred that hardened stool due to barium might have caused perforation at a fragile part where the intestinal muscularis propria was lacked. We report our experience of a very rare case of SAIM in an adult, together with a review of the literature.

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