Gastrointestinal perforation causes: Difference between revisions
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==Overview== | ==Overview== | ||
== Gastrointestinal perforation causes == | |||
=== Causes of gastrointestinal perforation in adults === | === Causes of gastrointestinal perforation in adults === | ||
====='''Instrumentation'''===== | ====='''Instrumentation'''===== | ||
*Instrumentation of the gastrointestinal tract includes upper endoscopy, sigmoidoscopy, colonoscopy | *Instrumentation of the gastrointestinal tract includes upper endoscopy, sigmoidoscopy, colonoscopy, stent placement, endoscopic sclerotherapy, nasogastric intubation, esophageal dilation, and surgery.<ref name="pmid19496201">{{cite journal| author=Akbulut S, Cakabay B, Ozmen CA, Sezgin A, Sevinc MM| title=An unusual cause of ileal perforation: report of a case and literature review. | journal=World J Gastroenterol | year= 2009 | volume= 15 | issue= 21 | pages= 2672-4 | pmid=19496201 | doi= | pmc=2691502 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19496201 }}</ref> | ||
*The area of the esophagus at most risk for instrumental perforation is Killian's triangle | *The area of the esophagus at most risk for instrumental perforation is Killian's triangle, which is the part of the pharynx formed by the inferior pharyngeal constrictor and cricopharyngeus muscle. | ||
*Gastrointestinal leakage can also occur postoperatively as a result of anastomotic breakdown. | *Gastrointestinal leakage can also occur postoperatively as a result of anastomotic breakdown.<ref name="pmid24074406">{{cite journal| author=Rickles AS, Iannuzzi JC, Kelly KN, Cooney RN, Brown DA, Davidson M et al.| title=Anastomotic leak or organ space surgical site infection: What are we missing in our quality improvement programs? | journal=Surgery | year= 2013 | volume= 154 | issue= 4 | pages= 680-7; discussion 687-9 | pmid=24074406 | doi=10.1016/j.surg.2013.06.035 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24074406 }}</ref> | ||
*[[Immunosuppressed]] individuals may be at increased risk for dehiscence and deep organ space infection following surgery. | *[[Immunosuppressed]] individuals may be at increased risk for dehiscence and deep organ space infection following surgery.<ref name="pmid21367368">{{cite journal| author=Ismael H, Horst M, Farooq M, Jordon J, Patton JH, Rubinfeld IS| title=Adverse effects of preoperative steroid use on surgical outcomes. | journal=Am J Surg | year= 2011 | volume= 201 | issue= 3 | pages= 305-8; discussion 308-9 | pmid=21367368 | doi=10.1016/j.amjsurg.2010.09.018 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21367368 }}</ref> | ||
=====Other causes===== | =====Other causes===== | ||
*Medications: [[aspirin]], [[potassium]], [[Disease-modifying antirheumatic drug|disease-modifying antirheumatic drugs]], and [[non-steroidal anti-inflammatory drug]] use has been associated with perforation. | *Medications: [[aspirin]], [[potassium]], [[Disease-modifying antirheumatic drug|disease-modifying antirheumatic drugs]], and [[non-steroidal anti-inflammatory drug]] use has been associated with perforation.<ref name="pmid14515298">{{cite journal| author=Morris CR, Harvey IM, Stebbings WS, Speakman CT, Kennedy HJ, Hart AR| title=Anti-inflammatory drugs, analgesics and the risk of perforated colonic diverticular disease. | journal=Br J Surg | year= 2003 | volume= 90 | issue= 10 | pages= 1267-72 | pmid=14515298 | doi=10.1002/bjs.4221 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=14515298 }}</ref> | ||
*Foreign bodies such as sharp objects, food with sharp surfaces, or gastric bezoar. | *Foreign bodies such as sharp objects, food with sharp surfaces, or gastric bezoar.<ref name="pmid27405509">{{cite journal| author=Strangfeld A, Richter A, Siegmund B, Herzer P, Rockwitz K, Demary W et al.| title=Risk for lower intestinal perforations in patients with rheumatoid arthritis treated with tocilizumab in comparison to treatment with other biologic or conventional synthetic DMARDs. | journal=Ann Rheum Dis | year= 2017 | volume= 76 | issue= 3 | pages= 504-510 | pmid=27405509 | doi=10.1136/annrheumdis-2016-209773 | pmc=5445993 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27405509 }}</ref> | ||
*Violent retching can lead to spontaneous esophageal perforation, known as [[Boerhaave syndrome]] due to increased intraesophageal pressure in the lower esophagus. | |||
*[[Peptic ulcer disease]] is the most common cause of [[stomach]] and duodenal perforation. | *[[Peptic ulcer disease]] is the most common cause of [[stomach]] and duodenal perforation. | ||
*Marginal ulcers may complicate procedures involving a [[gastrojejunostomy]]. | *Marginal ulcers may complicate procedures involving a [[gastrojejunostomy]]. | ||
*Perforated [[gastric ulcer]] is associated with a higher mortality. | *Perforated [[gastric ulcer]] is associated with a higher mortality.<ref name="pmid17993968">{{cite journal| author=Wu JT, Mattox KL, Wall MJ| title=Esophageal perforations: new perspectives and treatment paradigms. | journal=J Trauma | year= 2007 | volume= 63 | issue= 5 | pages= 1173-84 | pmid=17993968 | doi=10.1097/TA.0b013e31805c0dd4 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17993968 }}</ref> | ||
====='''Small intestine causes'''===== | ====='''Small intestine causes'''===== | ||
*Perforation of the [[small intestine]] can be related to [[bowel obstruction]], [[acute mesenteric ischemia]], [[inflammatory bowel disease]]. | *Perforation of the [[small intestine]] can be related to [[bowel obstruction]], [[acute mesenteric ischemia]], [[inflammatory bowel disease]].<ref name="pmid12725136">{{cite journal| author=Werbin N, Haddad R, Greenberg R, Karin E, Skornick Y| title=Free perforation in Crohn's disease. | journal=Isr Med Assoc J | year= 2003 | volume= 5 | issue= 3 | pages= 175-7 | pmid=12725136 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12725136 }}</ref> | ||
*[[Abdominal wall hernia|Abdominal wall]], [[Groin hernia|groin]], [[Diaphragmatic hernia|diaphragmatic]], [[internal hernia]], paraesophageal hernia, and [[volvulus]] can all lead to perforation either related to bowel wall ischemia. | *[[Abdominal wall hernia|Abdominal wall]], [[Groin hernia|groin]], [[Diaphragmatic hernia|diaphragmatic]], [[internal hernia]], paraesophageal hernia, and [[volvulus]] can all lead to perforation either related to bowel wall ischemia. | ||
*Injuries to the small intestine during laparoscopic procedures are often not recognized during the procedure. | *Injuries to the small intestine during laparoscopic procedures are often not recognized during the procedure. | ||
*[[Crohn's disease]] has a propensity to perforate slowly, leading to formation of entero-enteric or enterocutaneous [[fistula]] formation. | *[[Crohn's disease]] has a propensity to perforate slowly, leading to formation of entero-enteric or enterocutaneous [[fistula]] formation. | ||
*Diseases such as [[Typhoid fever|typhoid]], [[tuberculosis]], or [[schistosomiasis]] can perforate the small intestine. | *Diseases such as [[Typhoid fever|typhoid]], [[tuberculosis]], or [[schistosomiasis]] can perforate the small intestine. | ||
*The perforations usually occur in the ileum at necrotic [[Peyer's patches]]. | *The perforations usually occur in the ileum at necrotic [[Peyer's patches]].<ref name="pmid20555055">{{cite journal| author=Singh NG, Mannan AA, Kahvic M, Alanzi FM| title=Jejunal perforation caused by schistosomiasis. | journal=Trop Doct | year= 2010 | volume= 40 | issue= 3 | pages= 191-2 | pmid=20555055 | doi=10.1258/td.2010.090352 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20555055 }}</ref> | ||
=====Large intestine causes===== | =====Large intestine causes===== | ||
*Colonic [[diverticulosis]] is common in the developed world. They can become inflamed and perforate and may lead to [[abscess]] formation. | *Colonic [[diverticulosis]] is common in the developed world. They can become inflamed and perforate and may lead to [[abscess]] formation. | ||
*[[Mesenteric ischemia]] increases the risk for perforation. [[Embolism]], mesenteric occlusive disease, and [[heart failure]] lead to gastrointestinal ischemia. | *[[Mesenteric ischemia]] increases the risk for perforation. [[Embolism]], mesenteric occlusive disease, and [[heart failure]] lead to gastrointestinal ischemia. | ||
*[[Neoplasm|Neoplasms]] can perforate by direct penetration and [[necrosis]], or by producing obstruction. | *[[Neoplasm|Neoplasms]] can perforate by direct penetration and [[necrosis]], or by producing obstruction.<ref name="pmid17420936">{{cite journal| author=Ara C, Coban S, Kayaalp C, Yilmaz S, Kirimlioglu V| title=Spontaneous intestinal perforation due to non-Hodgkin's lymphoma: evaluation of eight cases. | journal=Dig Dis Sci | year= 2007 | volume= 52 | issue= 8 | pages= 1752-6 | pmid=17420936 | doi=10.1007/s10620-006-9279-x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17420936 }}</ref> | ||
=== Causes of spontaneous intestinal perforation in adults | === Causes of spontaneous intestinal perforation in adults === | ||
* [[Crohn's disease|Crohn’s disease]] | * [[Crohn's disease|Crohn’s disease]] | ||
* [[Celiac disease]] | * [[Celiac disease]] | ||
Revision as of 15:06, 8 January 2018
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Mohammed Abdelwahed M.D[2]
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Overview
Gastrointestinal perforation causes
Causes of gastrointestinal perforation in adults
Instrumentation
- Instrumentation of the gastrointestinal tract includes upper endoscopy, sigmoidoscopy, colonoscopy, stent placement, endoscopic sclerotherapy, nasogastric intubation, esophageal dilation, and surgery.[1]
- The area of the esophagus at most risk for instrumental perforation is Killian's triangle, which is the part of the pharynx formed by the inferior pharyngeal constrictor and cricopharyngeus muscle.
- Gastrointestinal leakage can also occur postoperatively as a result of anastomotic breakdown.[2]
- Immunosuppressed individuals may be at increased risk for dehiscence and deep organ space infection following surgery.[3]
Other causes
- Medications: aspirin, potassium, disease-modifying antirheumatic drugs, and non-steroidal anti-inflammatory drug use has been associated with perforation.[4]
- Foreign bodies such as sharp objects, food with sharp surfaces, or gastric bezoar.[5]
- Violent retching can lead to spontaneous esophageal perforation, known as Boerhaave syndrome due to increased intraesophageal pressure in the lower esophagus.
- Peptic ulcer disease is the most common cause of stomach and duodenal perforation.
- Marginal ulcers may complicate procedures involving a gastrojejunostomy.
- Perforated gastric ulcer is associated with a higher mortality.[6]
Small intestine causes
- Perforation of the small intestine can be related to bowel obstruction, acute mesenteric ischemia, inflammatory bowel disease.[7]
- Abdominal wall, groin, diaphragmatic, internal hernia, paraesophageal hernia, and volvulus can all lead to perforation either related to bowel wall ischemia.
- Injuries to the small intestine during laparoscopic procedures are often not recognized during the procedure.
- Crohn's disease has a propensity to perforate slowly, leading to formation of entero-enteric or enterocutaneous fistula formation.
- Diseases such as typhoid, tuberculosis, or schistosomiasis can perforate the small intestine.
- The perforations usually occur in the ileum at necrotic Peyer's patches.[8]
Large intestine causes
- Colonic diverticulosis is common in the developed world. They can become inflamed and perforate and may lead to abscess formation.
- Mesenteric ischemia increases the risk for perforation. Embolism, mesenteric occlusive disease, and heart failure lead to gastrointestinal ischemia.
- Neoplasms can perforate by direct penetration and necrosis, or by producing obstruction.[9]
Causes of spontaneous intestinal perforation in adults
- Crohn’s disease
- Celiac disease
- Graft-vs-host disease
- Infections:
- Viral: Cytomegalovirus
- Bacteria: Salmonella paratyphi, mycobacterium tuberculosis
- Parasites: Ascaris lumbricoides
- Protozoa: Entameba histolytica
- Drugs: NSAIDs and indomethacin
- Enteric-coated potassium chloride
- Monoclonal antibodies: Bevicuzimab
- Meckel’s diverticulum
- Radiation-induced vascular injury
- Atherosclerotic vascular occlusion
- Buerger’s disease
- Giant cell arteritis
- Wegener’s granulomatosis
- Henoch-schonlein purpura
- Allergic granulomatous arteritis
Causes of intestinal perforation in neonates
- Necrotising enterocolitis
- Spontaneous
- Iatrogenic
- Umbilical catheterization
- Umbilical cord clamping
- Nasogastric tube
- Obstruction
- Ileal atresia
- Gastric volvulus
- Gastroschisis
- Perforated inguinal hernia
- Malrotation/midgut volvulus
- Congenital band
References
- ↑ Akbulut S, Cakabay B, Ozmen CA, Sezgin A, Sevinc MM (2009). "An unusual cause of ileal perforation: report of a case and literature review". World J Gastroenterol. 15 (21): 2672–4. PMC 2691502. PMID 19496201.
- ↑ Rickles AS, Iannuzzi JC, Kelly KN, Cooney RN, Brown DA, Davidson M; et al. (2013). "Anastomotic leak or organ space surgical site infection: What are we missing in our quality improvement programs?". Surgery. 154 (4): 680–7, discussion 687-9. doi:10.1016/j.surg.2013.06.035. PMID 24074406.
- ↑ Ismael H, Horst M, Farooq M, Jordon J, Patton JH, Rubinfeld IS (2011). "Adverse effects of preoperative steroid use on surgical outcomes". Am J Surg. 201 (3): 305–8, discussion 308-9. doi:10.1016/j.amjsurg.2010.09.018. PMID 21367368.
- ↑ Morris CR, Harvey IM, Stebbings WS, Speakman CT, Kennedy HJ, Hart AR (2003). "Anti-inflammatory drugs, analgesics and the risk of perforated colonic diverticular disease". Br J Surg. 90 (10): 1267–72. doi:10.1002/bjs.4221. PMID 14515298.
- ↑ Strangfeld A, Richter A, Siegmund B, Herzer P, Rockwitz K, Demary W; et al. (2017). "Risk for lower intestinal perforations in patients with rheumatoid arthritis treated with tocilizumab in comparison to treatment with other biologic or conventional synthetic DMARDs". Ann Rheum Dis. 76 (3): 504–510. doi:10.1136/annrheumdis-2016-209773. PMC 5445993. PMID 27405509.
- ↑ Wu JT, Mattox KL, Wall MJ (2007). "Esophageal perforations: new perspectives and treatment paradigms". J Trauma. 63 (5): 1173–84. doi:10.1097/TA.0b013e31805c0dd4. PMID 17993968.
- ↑ Werbin N, Haddad R, Greenberg R, Karin E, Skornick Y (2003). "Free perforation in Crohn's disease". Isr Med Assoc J. 5 (3): 175–7. PMID 12725136.
- ↑ Singh NG, Mannan AA, Kahvic M, Alanzi FM (2010). "Jejunal perforation caused by schistosomiasis". Trop Doct. 40 (3): 191–2. doi:10.1258/td.2010.090352. PMID 20555055.
- ↑ Ara C, Coban S, Kayaalp C, Yilmaz S, Kirimlioglu V (2007). "Spontaneous intestinal perforation due to non-Hodgkin's lymphoma: evaluation of eight cases". Dig Dis Sci. 52 (8): 1752–6. doi:10.1007/s10620-006-9279-x. PMID 17420936.