Objective To investigate the cause, diagnosis and treatment of colonic perforation caused by constipation in the elderly. Methods The clinical data of 6 elderly patients with colonic perforation caused by constipation in our hospital during June 1980 and December 2008 was retrospectively analyzed. Results All patients had habitual constipation without defecation at least 4 d, or up to 13 d, the average time was 7.5 d. Without definite preoperative diagnosis, 4 cases were considered as colon cancer perforation, and 1 case as upper gastrointestinal perforation and 1 as acute suppurative appendicitis with perforation. They were all diagnosed by surgical exploration and pathological examination. 3 patients underwent perforation in the junction of rectum and sigmoid colon, 2 patients had ansa intestinalis of sigmoid colon, and 1 had descending colon perforation. 3 patients underwent partial resection of the sigmoid colon and epimere rectum and Hartman gastrostomy, 2 patients had proximal colon lumen colostomy repair, and 1 patient received a loop-type gastrostomy routine repair. 5 patients were cured, and 1 died of toxic shock infection. Conclusion Constipation is a high risk factor of spontaneous intestinal perforation in the elderly patients. Prevention and treatment of constipation may prevent complications.%目的 探讨老年人便秘致结肠穿孔的病因、诊断及治疗方法.方法 对我院1980年6月～2008年12月收治的6例老年便秘致结肠穿孔的临床资料进行回顾分析.结果 本组均为习惯性便秘患者,发病前未排便时间最短4 d,最长13d,平均7.5 d.术前均未明确诊断,考虑结肠癌性穿孔4例,上消化道穿孔、急性阑尾炎化脓并穿孔各1例.均经手术探查及病理检查明确病因.穿孔位于直肠、乙状结肠交界处3例,乙状结肠肠襻2例,降结肠1例.3例行部分乙状结肠及直肠上段切除Hartman造瘘术,2例行穿孔修补近端结肠双腔造瘘术,1例行穿孔修复襻式造瘘术.5例痊愈出院,1例死于感染中毒性休克.结论 便秘是导致老年人自发性肠穿孔的高危因素,预防及治疗便秘可防范由此导致的并发症.
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