Types and causes of intestinal perforation complicated by colorectal cancer

Intestinal perforation is a common complication of colorectal cancer. It can occur in any part of the body, with the highest level in the left colon and the lowest level in the hepatic and splenic flexures of the transverse colon. Clinically, there are typical acute abdominal manifestations, such as tense abdominal muscles, tenderness, rebound pain, and crescent-shaped gas under the diaphragm on X-ray films.

Types of colorectal cancer complicated by intestinal perforation:

1. Acute perforation: that is, free perforation, due to obstruction of distal colon cancer, the proximal expansion produces fecal ulcers and perforation, causing severe fecal peritonitis;

2. Subacute perforation: feces leaks out to form an abscess or inflammatory mass, which is the most common situation;

3. Chronic perforation: Colon cancer adheres to adjacent organs, causing chronic perforation and various colon fistulas.

Causes of colorectal cancer complicated by intestinal perforation:

1. When tumor-induced intestinal obstruction is complicated by intestinal perforation, the site of perforation is often not where the tumor is located, but proximal to the obstruction caused by the tumor.

2. Ulcerative cancer may not cause intestinal obstruction, but rather intestinal perforation due to the continuous growth of the tumor and nutritional disorders in the center of the cancer, which causes tissue necrosis, ulceration, and shedding. In the early stages of perforation, the main clinical manifestations are often high fever, localized abdominal pain, elevated blood counts, and palpable masses in the abdomen, but not necessarily acute abdomen.

3. Another type is due to the invasive growth of the tumor and the adhesion of the surrounding organs such as the bladder, uterus, small intestine, vagina, etc. When the cancerous lesions become necrotic and fall off, they can penetrate the affected adjacent organs and form internal fistulas.