Gastrointestinal perforation natural history

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Mohammed Abdelwahed M.D[2]

Gastrointestinal perforation Microchapters
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Overview
Historical Perspective
Classification
Pathophysiology
Causes
Differentiating gastrointestinal perforation from other diseases
Epidemiology and Demographics
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Natural History, Complications and Prognosis
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Complications

The incidence of complications ranges from 22 to 29 percent [2,82]. Common postoperative complications include:

• Systemic complications such as pneumonia, renal dysfunction and thromboembolism
• Complications specific to abdominal surgery: [10,13,96]
• Surgical site infection: It is common in patients with gastrointestinal injury. Surgical site infection occurred in 14 percent of patients. [98].
• Sepsis
• Intraabdominal abscess
• Shock

Prognosis

• Prognosis of GIT perforation is related to a delay in initial diagnosis. A delay in diagnosis more than 24 hours in patients found to have isolated blunt small bowel injury was associated with a higher mortality compared with diagnosis at <24 hours. [2].
• Patients with small bowel injury were significantly more likely to die compared with patients sustaining blunt abdominal trauma who did not have small bowel injury. [2].[8]
• Mortality rates for patients sustaining a ruptured stomach have been reported between 28 and 66 percent. [1,2,8].
• Colon-injury-related mortality rate of 1.3 percent. [82].
• Sepsis has a high mortality rate. Data derived from death certificates report that sepsis is responsible for 6 percent of all deaths while administrative claims data suggest higher rates [74].
• Mortality rates increase linearly according to the disease severity of sepsis [40].
• The mortality associated with sepsis was 10 percent while that associated with septic shock was 40 percent [27].
• Mortality appears to be lower in younger patients (<44 years) without comorbidities. Characteristics that impact the severity of sepsis and, therefore, the outcome include the host's response to infection, the site and type of infection, and the timing and type of antimicrobial therapy. [4]

• Long-term survival of infants with spontaneous intestinal perforation (SIP) has improved over the past 30 years with reported survival rates of 64 to 90 percent, regardless of treatment with primary peritoneal drainage (PPD) or laparotomy [4,5,33,35,40,45].
• The increase in survival is due to advances in neonatal care including improved parenteral nutrition and antibiotics. Patients with spontaneous intestinal perforation appear to have a lower mortality rate compared with patients with surgically treated necrotizing enterocolitis (NEC) or NEC with perforation [46-48].