Article Text

Download PDFPDF
An unusual case of caecal perforation following ileostomy reversal
  1. Gamze Aksakal1,
  2. Suat Ng2 and
  3. Vinna An1
  1. 1 Department of Surgery, Eastern Health, Box Hill, Victoria, Australia
  2. 2 Department of Surgery, St Vincents Hospital, Melbourne, Victoria, Australia
  1. Correspondence to Dr Gamze Aksakal, gamze.aksakal{at}


A 63-year-old man with a history of gastro-oesophageal reflux disease underwent defunctioning loop ileostomy for obstructing metastatic rectal cancer prior to receiving long-course neoadjuvant chemoradiotherapy. Four months post completion of neoadjuvant therapy, he underwent an uncomplicated elective ultra-low anterior resection with formation of colonic J pouch and first stage liver metastasectomy for bilobar liver disease. At 1 year, he proceeded to an elective closure of loop ileostomy. Unfortunately, his postoperative course was complicated by profuse diarrhoea with subsequent colonic perforation, necessitating an emergency laparotomy and ileocolic resection with end ileostomy formation. Histopathology and stool studies were consistent with Salmonella Typhi infection. At the present time, Salmonella Typhi causing toxic megacolon and subsequent colonic perforation is an uncommon phenomenon in Australia. Here, we present an unusual case and explain why bowel perforation in this instance likely had a multifactorial aetiology.

  • colon cancer
  • gastrointestinal surgery
  • general surgery
  • surgical oncology

Statistics from


  • GA and SN are the joint first authors.

  • Contributors GA and SN contributed equally to the manuscript. VA was involved with the patient’s care and contributed to the paper with regard to editing the final draft and providing feedback.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Patient consent for publication Next of kin consent obtained.

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.