Spontaneous perforation of the caecum case reports and a review of the literature R . YEO

PERFORATION of the healthy caecum is an uncommon condition. It may occur as a result of distal large bowel obstruction, unrelieved volvulus of the caecum, trauma to the right side of the abdomen, or ingested foreign bodies, e.g. a fish-bone or tooth-pick. Spontaneous perforation of the caecum in the absence of any of the above factors is exceedingly rare. In an extensive search of the English literature, only four such cases could be found (see Table 1). Low & Fairley (1934) described a case of perforation occurring in a patient suffering from tropical sprue. Two other cases occurred in the postpartum period, one following natural childbirth, and the other after Caesarean section (Robertson, Eddy & Vosseler, 1958; Hirsch, 1961). Another case arose in an elderly woman who had had a fall and sustained injuries of her left shoulder and chest wall (Eckman, Wenske & Abramson, 1958). Two further cases are reported here, where perforation of the caecum occurred following left inguinal herniorrhaphy and left nephrectomy respectively.