What are the predictive factors of caecal perforation in patients with obstructing distal colon cancer?
AIM
In the presence of large bowel obstruction, the choice of treatment is determined by the patient's general status, the tumour characteristics and the perceived risk of caecal perforation. This study was designed to evaluate the predictive factors of impending caecal perforation, and also investigated the use of caecal volumetry.


METHOD
From January 2011 to June 2016, patients with obstructive distal colon cancer undergoing emergency laparotomy, for whom a pretreatment CT scan was available, were included in this retrospective, case-control, two-centre study. Two patient groups were defined: patients with and without impending caecal perforation. The primary end-point of the study was a determination of predictive factors for caecal perforation.


RESULTS
A total of 72 patients (45 men, 62.5%) were included. Univariate analysis revealed that the presence of pericaecal fluid (P < 0.0001), caecal pneumatosis (P < 0.0001), mean maximum caecal diameter (P = 0.001), mean caecal diameter at the ileocaecal junction (P = 0.0001) and mean caecal volume (P = 0.001) were associated with caecal perforation. Receiver operating characteristic curve analysis revealed that a caecal volume greater than 400 cm3 (P < 0.0001), a maximum caecal diameter > 9 cm (P = 0.002) and a caecal diameter at the ileocaecal junction > 7.5 cm (P = 0.001) were associated with impending caecal perforation. In multivariate analysis, only caecal volume > 400 cm3 (P = 0.001) was correlated with the risk of impending caecal perforation.


CONCLUSION
Caecal volumetry is an easy and useful tool to predict impending caecal perforation in patients with large bowel obstruction.
['Sabbagh|C|C|', 'Siembida|N|N|', 'Yzet|T|T|', 'Robert|B|B|', 'Chivot|C|C|', 'Browet|F|F|', 'Mauvais|F|F|', 'Regimbeau|J M|JM|']
D000368:Aged D000369:Aged, 80 and over D001202:Ascitic Fluid D002429:Cecal Diseases D003110:Colonic Neoplasms D005260:Female D006801:Humans D007415:Intestinal Obstruction D007416:Intestinal Perforation D008297:Male D008875:Middle Aged D009929:Organ Size D011006:Pneumatosis Cystoides Intestinalis D012372:ROC Curve D012307:Risk Factors D014057:Tomography, X-Ray Computed
CT scan Colonic obstruction cecal perforation