Gastrointestinal perforation classification: Difference between revisions
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==Overview== | ==Overview== | ||
Gastrointestinal perforation may be classified based upon the [[etiology]] into instrumental perforation, perforation due to [[systemic diseases]], perforation due to [[inflammatory]] causes, [[medications]] and [[neoplasms]]. Gastrointestinal perforation may also be divided based on age of the patient into adult type and neonatal type perforation. | |||
==Gastrointestinal perforation classification== | ==Gastrointestinal perforation classification== | ||
There is no specific classification for gastrointestinal perforation but it can be classified by cause and by age of | There is no specific classification for gastrointestinal perforation but it can be classified by cause and by age of the patients. | ||
=== Gastrointestinal perforation can be classified by causes into: === | === Gastrointestinal perforation can be classified by causes into: === | ||
===== Instrumental: ===== | ===== Instrumental: ===== | ||
* Instrumentation of the gastrointestinal tract includes [[upper endoscopy]], [[sigmoidoscopy]], [[colonoscopy]], [[stent]] placement, [[Sclerotherapy|endoscopic sclerotherapy]], [[nasogastric intubation]], esophageal dilation, and surgery. | * Instrumentation of the gastrointestinal tract includes [[upper endoscopy]], [[sigmoidoscopy]], [[colonoscopy]], [[stent]] placement, [[Sclerotherapy|endoscopic sclerotherapy]], [[nasogastric intubation]], [[esophageal]] dilation, and [[surgery]]. | ||
* 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. | * The area of the [[esophagus]] at most risk for instrumental perforation is [[Killian's dehiscence|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. | ||
* [[Immunosuppressed]] individuals may be at increased risk for | * [[Immunosuppressed]] individuals may be at increased risk for perforation and deep organ space [[infection]] following [[Surgery operation|surgery]]. | ||
===== | ===== Systemic: ===== | ||
* [[Crohn's disease|Crohn’s disease]] | * [[Crohn's disease|Crohn’s disease]] | ||
* [[Celiac disease]] | * [[Celiac disease]] | ||
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===== Inflammatory ===== | ===== Inflammatory ===== | ||
* [[Crohn's disease]] has a propensity to perforate slowly, leading to formation of entero-enteric or | * [[Crohn's disease]] has a propensity to perforate slowly, leading to formation of entero-enteric or [[Enterocutaneous Fistulas|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 | * The perforations usually occur in the [[ileum]] at [[necrotic]] [[Peyer's patches]]. | ||
===== Medication ===== | ===== Medication ===== | ||
* [[Aspirin]], [[potassium]], [[Disease-modifying antirheumatic drug|disease-modifying antirheumatic drugs]], and [[non-steroidal anti-inflammatory drug]] use | * [[Aspirin]], [[potassium]], [[Disease-modifying antirheumatic drug|disease-modifying antirheumatic drugs]], and [[non-steroidal anti-inflammatory drug]] use have been associated with perforation. | ||
===== Neoplasm ===== | ===== Neoplasm ===== | ||
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**[[Nasogastric intubation|Nasogastric tube]] | **[[Nasogastric intubation|Nasogastric tube]] | ||
**[[Obstruction]] | **[[Obstruction]] | ||
** | **[[Ileum|Ileal]] [[atresia]] | ||
**[[Gastric volvulus]] | **[[Gastric volvulus]] | ||
**[[Gastroschisis]] | **[[Gastroschisis]] | ||
Revision as of 15:42, 1 March 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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Risk calculators and risk factors for Gastrointestinal perforation classification |
Overview
Gastrointestinal perforation may be classified based upon the etiology into instrumental perforation, perforation due to systemic diseases, perforation due to inflammatory causes, medications and neoplasms. Gastrointestinal perforation may also be divided based on age of the patient into adult type and neonatal type perforation.
Gastrointestinal perforation classification
There is no specific classification for gastrointestinal perforation but it can be classified by cause and by age of the patients.
Gastrointestinal perforation can be classified by causes into:
Instrumental:
- Instrumentation of the gastrointestinal tract includes upper endoscopy, sigmoidoscopy, colonoscopy, stent placement, endoscopic sclerotherapy, nasogastric intubation, esophageal dilation, and surgery.
- 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.
- Immunosuppressed individuals may be at increased risk for perforation and deep organ space infection following surgery.
Systemic:
- 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: Bevacizumab
- Meckel’s diverticulum
Inflammatory
- 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.
Medication
- Aspirin, potassium, disease-modifying antirheumatic drugs, and non-steroidal anti-inflammatory drug use have been associated with perforation.
Neoplasm
Gastrointestinal perforation can be classified by age into:
- Adult-type gastrointestinal perforation
- Neonatal gastrointestinal perforation:
- Necrotising enterocolitis
- Spontaneous
- Iatrogenic
- Umbilical catheterization
- Umbilical cord clamping
- Nasogastric tube
- Obstruction
- Ileal atresia
- Gastric volvulus
- Gastroschisis
- Perforated inguinal hernia