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To the Editor:
—The report of the case of perforation of the sigmoid colon after the ingestion of a hydrophilic colloid (J.A.M.A.154:1273 [April 10] 1954) teaches a very important lesson. Never administer bulk-producing substances without first making certain that no fecal impaction is present. From the description of the symptoms as they developed, it is quite obvious that such was the case. The reverse peristalsis (severe abdominal cramps, emesis, later perforation) was due to intestinal obstruction, in turn due to fecal impaction. The patient passed "small, hard, fecal marbles." He later passed a "huge mass of stool after straining." This surely was not all the fecal material that had accumulated in the lower colon. The authors correctly state that it was "presumed that the perforation in this patient occurred as a result of a temporary obstruction to the bowel contents... with gradual increase in the bulk of the
Sagal Z. PERFORATION OF SIGMOID COLON. JAMA. 1954;155(8):775. doi:10.1001/jama.1954.03690260067027