Unusual pressure-induced rupture of colonic volvulus in a patient with long-term corticosteroid therapy

Perforation due to colonic volvulus is typically considered to occur following ischemic necrosis of the intestinal wall. In this report, we report a rare case of sigmoid colon volvulus rupture caused by increasing intraluminal pressure without any sign of ischemia. The patient was an 88-year old Japanese male, who had been treated with 5 mg of oral prednisolone daily for 8 years. He consulted for severe abdominal pain that had lasted for three days. X-ray and computed tomography showed free peritoneal air, sug- gesting peritonitis. He was diagnosed with sigmoid colon volvulus perforation and underwent emergency surgery. Pathological exam- ination showed no ischemic necrosis around the perforations in the resected intestine. As a result, we came to believe that the fragility of the colonic wall, caused by the patient's long-term use of corti- costeroid, had lowered the threshold for pressure-induced colonic rupture. (Acta gastroenterol. belg., 2008, 71, 339-341).