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Background: A prospective study was conducted on 100 patients of perforation peritonitis: To find out the incidence of gastro intestinal perforation in various age groups, sex, riral or urban, socio economic status, To find out the various causes and sites of gastra intestinal perforartions, To determine various types of procedures being done to treat gastro intestinal perforations.Methods:The study population consisted of 100 patients of perforation peritonitis admitted at surgical wards of Rajindra Hospital, Patiala. Patients underwent necessary investigations such as Blood counts, biochemical analysis and urine analysis. X-ray Abdomen and chest / USG Abdomen/Pelvis CT-Abdomen (as and when required). All diagnosed patients were subjected to surgery. In all cases, operative findings and postoperative course were followed up for three months. Final outcome was evaluated on the basis of clinical, operative and radiological findings. In pre-pyloric and duodenal perforation, GRAHAM扴 PATCH REPAIR carried out. In Ileal and Jejunal perforations, primary closure or exteriorization done depending upon the condition of the gut and duration of the symptoms. The patient outcome was assessed by duration of hospital stay, wound infection, wound dehiscence, leakage/entero-cutaneous fistula, intra-abdominal collection/abscess, ileostomy related complications and reoperation. Wound infection was graded as per SSI grading.Results:Most common age group for perforation was 21-40 years (50%) followed by 41-60 (33%) years in present study. Mean age of the patients is 37.91 + 13.15 years with male predominance (78%) in our study. 4% of the patients were of upper socio-economic status while 32% of the patients were of middle and 64% of the patients were of lower socio-economic status.Abdominal pain was seen in 100% of the patients while abdominal distension was present in 69% of the patients. Nausea/Vomiting was seen in 61% of the patients while Fever and Constipation was seen in 53% and 86% of the patients respectively. Diarrhoea was seen in 3% of the patients. Tenderness, guarding & rigidity, distension, obliteration of liver dullness and evidence of free fluid were present in 100% of the patients. Bowel sounds were not detected in all the patients. Most common perforations were Duodena(37%), Ileal (25%), Gastric (25%) followed by Appendicular (9%), Jejunal (4%) and Colonic perforation (2%). The most common etiology of gastrointestinal perforations was Peptic ulcer followed by Typhoid, Appendicitis, Tuberculosis, Trauma, Malignancy and non-specific infection.In Gastric perforations, Peptic ulcer was the most common cause of perforation followed by Trauma. In Ileal perforations, Typhoid was the most common cause of perforation followed by Tuberculosis and non-specific infection. In Appendicular perforations, most common cause was Appendicitis. In Jejunal perforations, most common cause was Trauma. In Colonic perforations, most common cause was Malignancy.Conclusions:The incidence of gastrointestinal perforations was common in 21-40 years age group followed by 41-60 years age group with male preponderance in our study. The most common site of perforations was Gastro-duodenal followed by Ileal perforations and the most common cause for these perforations was peptic ulcer followed by typhoid. The most common procedure done to treat gastrointestinal perforations was primary closure, resection and anastomosis, appendectomy and stoma formation. However, small sample size and short follow up period were the limitations of the present study.
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Introduction: Perforation peritonitis is the most commonsurgical emergency encountered all over the world. Theobjective of the study was to highlight the spectrum ofperforation peritonitis as encountered in a tertiary care centrein haryana.Material and methods: It was observational prospectivestudy of 100 cases of perforation peritonitis treated in thedepartment of surgery. The maximum number of patients inthe present study were in age group of 21-30 years (26%) witha mean age was 31 years. Male female ratio was 8.09:1.Results: The most common etiology of perforation peritonitiswas peptic ulcer disease (41%) followed by enteric fever (15%)and tuberculosis (13%)The most common site of perforationin this series was gastroduodenal (43%) followed by terminalileum (30%). Mortality rate was 5% and significantly high inpatients coming to the hospital after 24 hours.Conclusion: Early recognition of symptoms and referral isvery important in reducing mortality and morbidity
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Objective To explore the cause,clinical manifestation,diagnosis,treatment and prognosis of neonatal gastrointestinal perforation (GIP),for the purpose of improving treatment and prognosis.Methods Clinical data of neonates diagnosed as GIP in our hospital were reviewed retrospectively from 2011 to 2015.The etiology,clinical manifestation and prognosis were evaluated,and multiple-variate analysis was employed to discriminate mortality risk factors.Reanlts One hundred and eleven neonates with complete clinical records were identified.Seventy-six were boys and 35 were girls.Caesarean were more common than vaginal delivery.Preterm neonates were more common than term baby (61 vs.50),and low-birth-weight neonates were more common.Mortality for boys and girls were 19.7％ and 31.6％ respectively (P ＜0.05).Abdominal distention was the most symptoms,and perforation caused by NEC (necrotizing enterocolitis) manifested differently from other perforations.Pneumoperitoneum was reported only in 64％ with plain abdominal x-ray.NEC accounted for most of GIP in our study,and other causes were gastric rupture,intestinal atresia,spontaneous intestinal perforation (SIP) and Hirschsprung's disease.GIP caused by NEC had the highest mortality,but the difference was not significant among groups.Heum was the most common site of perforation.Incision infection was the most postoperative complication.73 ％ infants were cured eventually with an overall mortality rate of 27 ％.Conclusion Main mortality risk factors included gender,weight,respiratory complications,ventilation,etc.,while gestational age,respiratory distress at birth,perforation site and multiple perforations seemed have nothing to do with the mortality.Pneumoperitoneum on plain film is still the first choice of diagnosis.Abdominal ultrasound is useful for the diagnosis of GIP.
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Objective To observe the value of MSCT in diagnosis of gastrointestinal foreign bodies and the resulting gastrointestinal perforations.Methods MSCT and clinical data of 30 patients with gastrointestinal foreign bodies,including 17 with gastrointestinal perforations were reviewed retrospectively.The location,morphology,density of foreign bodies,and the performances of gastrointestinal perforations were observed.Results All gastrointestinal foreign bodies could be displayed by MSCT in 30 patients.Toothpicks were the most common type of foreign bodies (12/30,40.00％),followed by fish bones (5/30,16.67％),jujube nuclei (3/30,10.00％),chicken bones (2/30,6.67％) and so on.Foreign bodies were found in small intestine in 15 patients (15/30,50.00％),in stomach in 7 (7/30,23.33％),in colon in 6 (6/30,20.00％) and in ileocecus in 2 patients (2/30,6.67％).High density foreign bodies were demonstrated on abdominal X-ray films in 11 patients (11/30,36.7 ％).Gastrointestinal perforations caused by toothpicks,fishbones and other sharp objects were observed in 14 patients (14/17,82.35 ％).Intestinal wall edema,peripheral exudation,foreign bodies "cross through the intestinal wall" and the surrounding small bubbles were found in perforation site or nearby.Conclusion MSCT can comprehensively display the location,shape and associated changes of gastrointestinal foreign bodies,with important diagnostic value for gastrointestinal perforations.
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Objective To investigate the diagnosis,clinical features and treatment of HIV patients complicated with gastrointestinal perforation.Methods There were 17 patients with gastrointestinal perforation and HIV infection,and the clinical data were retrospectively analyzed.Results Abdominal X-ray examination was used to establish the diagnosis,with perforation site at the duodenal bulb in 5 cases,gastric pylorus in 3 cases,ileocecal and terminal ileum in 9 cases.7 cases were co-complicated with tuberculosis infection,1 case with Penicillium mameffei infection,15 were cured and 2 cases died.Conclusions Possible for compromised immunc function,gastrointestinal perforation in HIV patients often found in site less common in otherwise normal cases,and co-infection is common in HIV patients.
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Objective To analyze and compare the complications of laparotomysurgery and laparoscopic surgery for upper gastrointestinal perforation.Methods Retrospective analyzed the clinical data of 113 patients,including 100 male cases,13 female cases,aged 17 to 87 years old,mean (51.42 ± 17.11) years old,with perforation in stomach and duodenum at Chinese People's Liberation Army General Hospital from January 2008 to January 2017.The patients were divided into laparotomy group (64 cases) and laparoscopic group (49 cases) according to the operation mode,and the intraoperative blood loss and postoperative complications were compared.The measurement data were expressed by ((-x) ± s),and the t test was used between the groups.The count data were expressed by ratio or percentage,the chi-square test was used.Results The amount of bleeding in laparoscopic group was (51.90 ± 18.91) ml,was significantly less than that of laparotomy group (74.60 ± 10.23) ml (x2 =8.186,P =0.000).Postoperative complications occurred in 28 patients (24.8％) in 113 patients,and the top three complications were incision infection,pneumonia,and anastomotic or patch bleeding.The incidence of postoperative complications in laparotomy group and laparoscopic group was 29.7％ (19/64) and 18.4％ (9/49),respectively,and there was no significant difference (x2 =1.908,P =0.193).Conclusion The two kinds of operation methods of upper digestive tract perforation are similar,and the amount of bleeding in laparoscopic operation group is less than that in laparotomy group,at the same time,higher technical requiremnents are need to be completed by experienced doctors for minimally invasive surgery.
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Objective To assess the efficacy and safety of over-the-scope clip(OTSC) system in treatment of the perforation ,fistula and bleeding of the digestive tract .Methods The data of 33 patients who were treated with OTSC in our department were analyzed retrospective-ly,and the technical success rate ,clinical success rate and complications were statistically analyzed .Among the 33 patients,there were 14 pa-tients with upper gastrointestinal bleeding , 8 patients with postoperative fistula , and 11 patients with endoscopic full-thickness resection (EFTR) of gastric or duodenal bulb.Results The technical success rate and clinical success rate of 33 cases were 96.97% and 93.94%respectively,and there was no complication in all patients .Among them,the clinical success rate of the upper gastrointestinal bleeding was 92.85%,the anastomotic fistula was 75.00%,and the EFTR was 100%.Conclusion As a new type of clinical endoscopic suture system , OTSC is safe and effective in gastrointestinal bleeding ,perforation and fistula .
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Objective To analyze clinical data of anorectal malformations(ARM)in children with gastrointes-tinal perforation and explore the features and risk factors associated with gastrointestinal perforation. Methods A retro-spective review was performed in all children with ARM at the Second Affiliated Hospital of Xi′an Jiaotong University from September 2011 to September 2016. The association between gastrointestinal perforations and other factors were statistically analyzed,such as low birth weight,premature birth,delayed diagnosis,and the type of ARM. Based on the related literatures obtained from PubMed,Web of Science and Wanfang database,the clinical characteristics were ex-plored in patients with gastrointestinal perforation complicated with ARM. Results A total of 143 patients with ARM were included in the study,of whom 17 cases belonged to delayed diagnosis,16 cases with low birth weight patients,21 case were premature infants. In all patients,3 patients were complicated with gastrointestinal perforation,and the diagnosis of 2 cases were delayed,2 cases had low birth weight,1 case was premature infant,and the perforation sites were all loca-ted in the sigmoid colon or rectum. Statistical analysis showed that perforation was associated with delayed diagnosis(P =0. 037)and low birth weight(P = 0. 033),however,perforation was not associated with prematurity(P = 0. 381)or the type of ARM(χ2 =0. 000,P =1. 000). A total of 23 cases with complete clinical data in 15 English literatures and 3 cases in the Second Affiliated Hospital of Xi′an Jiaotong University were summarized. The reviewing showed that 92％ of perfo-rations occurred before surgical decompression of the obstructed colon,and 68％ of perforations occurred in the sigmoid colon or rectum. Conclusions Gastrointestinal perforation is a rare complication in ARM. And it is associated with delayed diagnosis,as well as low birth weight or the distal bowel canal underdevelopment. Careful perineal examination will clearly identify the existence of ARM and therefore delayed diagnosis can be totally avoided. Thus,the incidence of bowel perforation in patients with ARM can be reduced effectively.
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Objective To observe the clinical features and evaluate the risk factors affecting prognosis in patients with secondary sepsis of gastrointestinal perforation (GIP). Methods A retrospective cohort study was conducted, and the patients with GIP admitted to the Department of General Surgery of Affiliated Shuyang People's Hospital of Xuzhou Medical University from January 1, 2014 to April 30, 2017 were enrolled, according to the presence or absence of sepsis occurrence, they were divided into GIP with and GIP without sepsis groups. The difference of gender, age, the time between the onset of GIP and the occurrence of sepsis, infection situation, body temperature, heart rate, respiratory frequency, white blood cell count (WBC), systemic inflammatory response syndrome (SIRS) in accord with standard, C-reactive protein (CRP), blood sugar, mean arterial pressure (MAP), lactic acid, number of cases having undergone laparoscopic surgery, sequential organ failure score (SOFA) and quick sequential organ failure score (qSOFA), Glasgow coma score(GCS), length of stay in intensive care unit (ICU), the total length of stay in hospital were compared;the status of survival and prognosis was assessed on day 30 by the Glasgow Outcome Scale (GOS). The indicators with statistical significance in the two groups were brought into the Cox regression model to analyze the independent risk factors affecting the prognosis of the patients. Results Fifty-eight patients with GIP were enrolled in this study. Among them, 22 cases developed secondary sepsis (GIP with sepsis group, there were 50.0% cases with single organ failure and 50.0% cases with multiple-organ failure, cases only in accord with 0-1 SIRS criteria accounting for 81.8%, and the mortality of secondary sepsis being 31.8%). No sepsis occurred in 36 patients (GIP without sepsis group). In GIP with sepsis group, the age, blood glucose, lactic acid, SOFA score, qSOFA, and the length of stay in ICU were significantly higher than those of GIP without sepsis group [age (years): 68.7±15.9 vs. 56.1±17.2, blood glucose (mmol/L): 6.9±2.3 vs. 5.9±1.2, lactic acid (mmol/L): 2.9±1.3 vs. 1.2±0.7, SOFA score: 5.6±3.2 vs. 0.5±0.4, qSOFA score: 1.0±0.9 vs. 0.3±0.1, the length of stay in ICU (days): 1.0 (0-4.0) vs. 0.1 (0-2.0), all P < 0.05], while MAP, GCS, and GOS scores in GIP with sepsis group were significantly lower than those in GIP without sepsis group [MAP (mmHg, 1 mmHg =0.133 kPa): 83.6±18.7 vs. 100.0±14.3, GCS score: 12.8±3.5 vs. 14.5±0.5, GOS score: 3.5±1.9 vs. 4.9±0.2, all P < 0.01]. Cox multivariable regression analysis showed: only low MAP and low GCS score were the independent risk predictors of death outcome for GIP with sepsis, the relative risk (RR) was 0.896 [95% confidence interval (CI) = 0.815-0.984, P = 0.022] and 0.585 (95%CI = 0.395-0.866, P = 0.007) respectively. Conclusion Patients with secondary sepsis following GIP have relatively high morbidity and much more risk factors, but only low MAP and low GCS score are closely associated with its high risk of death.
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Objective To observe the clinical features and evaluate the risk factors affecting prognosis in patients with secondary sepsis of gastrointestinal perforation (GIP). Methods A retrospective cohort study was conducted, and the patients with GIP admitted to the Department of General Surgery of Affiliated Shuyang People's Hospital of Xuzhou Medical University from January 1, 2014 to April 30, 2017 were enrolled, according to the presence or absence of sepsis occurrence, they were divided into GIP with and GIP without sepsis groups. The difference of gender, age, the time between the onset of GIP and the occurrence of sepsis, infection situation, body temperature, heart rate, respiratory frequency, white blood cell count (WBC), systemic inflammatory response syndrome (SIRS) in accord with standard, C-reactive protein (CRP), blood sugar, mean arterial pressure (MAP), lactic acid, number of cases having undergone laparoscopic surgery, sequential organ failure score (SOFA) and quick sequential organ failure score (qSOFA), Glasgow coma score(GCS), length of stay in intensive care unit (ICU), the total length of stay in hospital were compared;the status of survival and prognosis was assessed on day 30 by the Glasgow Outcome Scale (GOS). The indicators with statistical significance in the two groups were brought into the Cox regression model to analyze the independent risk factors affecting the prognosis of the patients. Results Fifty-eight patients with GIP were enrolled in this study. Among them, 22 cases developed secondary sepsis (GIP with sepsis group, there were 50.0% cases with single organ failure and 50.0% cases with multiple-organ failure, cases only in accord with 0-1 SIRS criteria accounting for 81.8%, and the mortality of secondary sepsis being 31.8%). No sepsis occurred in 36 patients (GIP without sepsis group). In GIP with sepsis group, the age, blood glucose, lactic acid, SOFA score, qSOFA, and the length of stay in ICU were significantly higher than those of GIP without sepsis group [age (years): 68.7±15.9 vs. 56.1±17.2, blood glucose (mmol/L): 6.9±2.3 vs. 5.9±1.2, lactic acid (mmol/L): 2.9±1.3 vs. 1.2±0.7, SOFA score: 5.6±3.2 vs. 0.5±0.4, qSOFA score: 1.0±0.9 vs. 0.3±0.1, the length of stay in ICU (days): 1.0 (0-4.0) vs. 0.1 (0-2.0), all P < 0.05], while MAP, GCS, and GOS scores in GIP with sepsis group were significantly lower than those in GIP without sepsis group [MAP (mmHg, 1 mmHg =0.133 kPa): 83.6±18.7 vs. 100.0±14.3, GCS score: 12.8±3.5 vs. 14.5±0.5, GOS score: 3.5±1.9 vs. 4.9±0.2, all P < 0.01]. Cox multivariable regression analysis showed: only low MAP and low GCS score were the independent risk predictors of death outcome for GIP with sepsis, the relative risk (RR) was 0.896 [95% confidence interval (CI) = 0.815-0.984, P = 0.022] and 0.585 (95%CI = 0.395-0.866, P = 0.007) respectively. Conclusion Patients with secondary sepsis following GIP have relatively high morbidity and much more risk factors, but only low MAP and low GCS score are closely associated with its high risk of death.
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Objective To study the distribution characteristics of intraperitoneal free gas and the location value of the site of gastrointestinal perforation using multi-slice CT (MSCT).Methods 60 cases of gastrointestinal perforation were retrospectively collected.The distribution of the intraperitoneal free gas in CT image was analyzed and observed.The digestive tract were divided to the upper digestive tract and the lower digestive tract by Treitz ligament.The distribution of the intraperitoneal free gas was analyzed using χ2 test.The distribution of the intraperitoneal free gas between each different perforational site was analyzed.Results 38 cases of the site of gastrointestinal perforation located in upper gastrointestinal tract and 22 cases located in lower gastrointestinal tract,there was statistically significant difference between the upper digestive tract and the lower digestive tract about the distribution of the intraperitoneal free gas(χ2=22.33,P0.05).In the cases of lower gastrointestinal tract perforation,11 cases of the site located in bowel and 11 cases located in colon,there was statistically significant difference between bowel and colon(χ2=8.98,P<0.05).Conclusion The MSCT distribution of the intraperitoneal free gas has important value in localization diagnosis of gastrointestinal perforation.
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Background: Gastrointestinal hollow viscous perforations constitute one of the important causes of acute pain abdomen in adults and if not treated properly may lead to significant morbidity and sometimes mortality. Successful treatment requires a thorough understanding of anatomy, microbiology, pathophysiology of the disease process and in-depth knowledge of the therapy, including resuscitation, antibiotics, source control, and physiologic support. Aim: To evaluate the etiopathology, clinical signs and symptoms, investigations in the management of gastrointestinal hollow viscous perforations. Materials and Methods: This was a prospective study conducted on patients presenting with gastrointestinal hollow viscous perforations to the Department of General Surgery, Rajarajeswari Medical College and Hospital over a period of 2-year from July 2013 to June 2015. A total of 110 patients were included in the study. A written, informed consent was taken from all patients before enrolling into the study. The Institutional Ethical Committee clearance was taken before starting the study. A pre-formed questionnaire was used to collect the clinical information from the patients. Results: The majority of the patients involved were males (81%) and in the age group of 30-50 years. 80% of the perforations were noted in the Gastroduodenal region, and the remaining was seen in the small bowel (13%) and appendix (7%). Pain abdomen was the presenting complaint in all patients (100%) while vomiting was seen in 50% and abdominal distension was seen in 80% of the patients. 91% of the patients had gas under the diaphragm. Wound infection (9%) lead the list of post-operative complications with a residual abscess (6%) following behind burst abdomen (4%) and fecal fistula (1%). 2% (2 patients) of patients died due to varied reasons. Conclusion: Even after the introduction of proton pump inhibitors, the incidence of perforations resulting from acid peptic disease is still high. Early recognition of perforation, prompt surgical intervention, good post-operative care, recognition of co-morbid conditions and early recognition, and management of complications would reduce morbidity and mortality.
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Objective To explore the clinical value of spiral CT in diagnosis of acute early gastrointestinal perforation.Methods The clinical data of 38 patients who were definitely diagnosed by pathology as acute early gastrointestinal perforation were retrospectively analyzed.All the patients received spiral CT and abdominal X-ray before surgery.The diagnosis and imaging finding of two methods were analyzed.Results The accuracy of spiral CT (89.5％) was significantly higher than that of X-ray(63.2％) (x2 =7.28,P ＜0.01).X-ray did poorly at displaying free gas at small amount and structures which was not subdiaphragmatic air but retroperitoneum or less omental,but spiral CT did good at that obviously so as to make accurate location and etiological diagnosis.Conclusion Spiral CT can display a small amount of abdominal free air earlier and more accurately,with a high accuracy of diagnosis at early gastrointestinal perforation,and can provide valuable information for location and etiological diagnosis.
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PURPOSE: This study was conducted to compare the clinical features and outcome of neonatal gastrointestinal perforation due to necrotizing enterocolitis (NEC) and other etiologic diseases (non-NEC). METHODS: The medical records of neonates, admitted to the neonatal intensive care unit of Dongsan Medical Center for gastrointestinal perforation between January 1999 and December 2009, were reviewed retrospectively. The admission records for clinical findings and mortality were reviewed and statistically analyzed for both groups. RESULTS: Among 28 neonates, NEC group was 35.7% and the other group (intestinal atresia, malrotation, meconium peritonitis, etc) was 64.3%. The mean gestational age was significantly shorter (32.8+/-4.6 weeks vs. 36.8+/-2.7 weeks, P=0.028) and the mean diagnostic day was significantly later (16.3+/-9.7 days vs. 2.2+/-1.8 days, P=0.001) in the NEC group than that of the non-NEC group. The mortality rate was markedly higher in the NEC group (50%) than that of the non-NEC group (5.6%)(P=0.013). By simple logistic regression analysis, gestational age (OR 0.69, 95% CI: 0.51-0.95, P=0.022) and NEC (OR 17.00, 95% CI: 1.60-181.36, P=0.019) were the significant risk factors to increase the mortality rate. Multiple logistic regression analysis showed NEC (OR 7.70, 95% CI: 0.55-108.06, P=0.130) and gestational age (OR 0.79, 95% CI: 0.58-1.09, P=0.151) were not the significant independent risk factors. CONCLUSIONS: This study found that gestational age was shorter and mortality rate was higher in the NEC group than the non-NEC group. However, after multiple logistic regression analysis, NEC or lower gestational age itself did not increase the mortality rate significantly.
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Humans , Infant, Newborn , Enterocolitis, Necrotizing , Gestational Age , Intensive Care, Neonatal , Logistic Models , Meconium , Medical Records , Peritonitis , Retrospective Studies , Risk FactorsABSTRACT
Objective To evaluate the value of the periportal free air(PPFA) sign at computed tomography(CT) in distinguishing between upper and lower gastrointestinal(GI) tract perforation. Methods CT images of 62 patients with surgically proven GI tract perforation were retrospectively analyzed. 62 cases included upper and lower GI tract perforation in 35 cases and 27 cases,respective-ly. When there was free air in the periportal area,it was defined as positive periportal free air(PPFA) sign. The difference of PPFA sign in upper and lower GI tract perforation, and the sensitivity, specificity, positive predictive value, negative predictive value and ac-curacy of PPFA sign in diagnosing gastrointestinal perforation were analysed respectively. Results The PPFA sign was seen in 33 of 35(94%) patients with upper GI tract perforation,but only in 10 of 27 (37%) patients with lower GI tract perforation,there was sig-nificant difference between them(P<0.05). For diagnosis of super GI perforation with PPFA sign, the sensitivity, specificity, positive predictive value,negative predictive value and accuracy were 94% (33/35), 63%(17/27), 770%(33/43), 89%(17/19) and 81% (50/ 62), respectively. Conclusion The PPFA sign is a useful finding in distinguishing between upper and lower GI tract perforation.
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Based on retrospective study of one case of foreign body-induced gastrointestinal perforation and systematic review of related literature, we found that foreign body induced-gastrointestinal perforation was characterized by low incidence and none specific clinical or imaging manifestations. Laparoscopy as a minimally invasive procedure could help to get definite diagnosis, while laparotomy seemed to be equally important in disease diagnosis and treatment.
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BACKGROUND: The APACHE scoring system of the Health Care Financing Administration (HCFA) has been being used for serious patients. The scoring system is composed of acute physiologic variables and chronic disease. METHODS: Among patients who underwent emergency operations from 1992 to 1997 because of gastrointestinal perforation, we analyzed 110 cases with five kinds of diseases: duodenal ulcer perforation, small bowel perforation, perforated appendicitis, gastric ulcer perforation and colon perforation. RESULTS: The results were as follows: 1) The preoperative APACHE II scores ranged from 0 to 21. The scores of 64 cases (60.9%) were from 0 to 5. 2) There were no death in case for which pre-peration APACHE II score was from 0 to 10, 25% of the mortality occurred in cases with scores from 11 to 15, 50% in those with scores from 16 to 20, and 100% in those with scores above 21. 3) The APACHE II score decreased continuously from the 3rd to the 7th postoperative day. 4) The preoperative APACHE II scores in gastric ulcer perforation patients were significantly higher than those in duodenal ulcer perforation patients. In the cases of gastric and duodenal ulcer perforations, the APACHE II scores in patients who underwent primary closure were higher than the scores in those who underwent a more definitive operation. 5) In death cases, all of their APACHE II scores were higher at the 3rd postoperative than at the 7th postoperative day, but their APACHE III scores continuously increased postoperatively. CONCLUSIONS: It is thought that the APACHE scoring system is more reliable than clinical experience in the classification of patients by operative risk and in estinating the result and giving a prognosis. Thus, the principle of treatment should be established by estinating patient's score before the operation. Careful preoperative management is necessary for patients with scores more than 10. Because patientswith scores more than 21 have very a high mortality, operative time and method must be carefully decided. The APACHE III scoring system seems to be more sensitive than the APACHE II scoring system in predicting deaths and further investigations and clinical applications should be performed.
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Humans , APACHE , Appendicitis , Chronic Disease , Classification , Colon , Duodenal Ulcer , Emergencies , Mortality , Operative Time , Prognosis , Stomach UlcerABSTRACT
Perforation of the gastrointestinal tract in neonatal period has been associated with a grim prognosis even with some improvement in survival. To evaluate the remaining pitfalls in management, 19 cases of neonatal gastrointestinal perforation from May 1989 to July 1996 were analysed retrospectively. Seven of them were premature and low birth weight infants. Perforation was most common in ileum (56.3%). Mechanical or functional obstruction distal to the perforation site was identified in 7 cases, such as 3 of Hirschsprung's disease, 3 of small bowel atresia, and 1 of anorectal malformation. Among them, 2 of Hirschsprung's disease, 1 of small bowel atresia, and one anorectal malformation could be diagnosed only after perforation. Five cases of necrotizing enterocolitis and 1 of muscular defect were the other causes of perforation. But in 6 cases, a preceding cause was not identified. Perinatal ischemic episodes were associated in five cases. Overall mortality rate was 15.1%. Because a considerable number of gastrointestinal perforations were resulted from distal obstruction, pediatric surgeon should be alert for early identification and intervention of gastrointestinal obstruction, particularly in prematurity and history of ischemia.
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Humans , Infant , Infant, Newborn , Enterocolitis, Necrotizing , Gastrointestinal Tract , Hirschsprung Disease , Ileum , Infant, Low Birth Weight , Ischemia , Mortality , Prognosis , Retrospective StudiesABSTRACT
Children tend to ingest foreign bodies. The majority present in children between the ages of 6 months and 3 years. We experienced 2 cases of unusual gastrointestinal complications caused by ingested foreign bodies. First case was a 10-month-old male with intestinal perforation due to two pieces of ingested magnetic beads. Second case was a 7-month-old girl with esophageal stricture due to an ingested particle of plastic toy.