Colonic perforation complicates ulcerative colitis in about 3-5% of cases and typically occurs in the setting of toxic megacolon . Colonic perforation without megacolon should raise suspicion of Crohn's disease. However, perforation may also be seen in about 1% of acute colitis without colonic dilatation and is most commonly located in the sigmoid colon. Perforation may occur during diagnostic endoscopies performed without extreme caution. Free perforation is demonstrated on upright or lateral X-ray films. Sealed perforation, while not detected radiologically, is occasionally recognised as a palpable mass and always diagnosed at surgery. Free perforation is associated with high mortality rate . Therefore, whatever the cause of perforation, the patient should immediately undergo surgical exploration.
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