Gastrointestinal perforation causes: Difference between revisions

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Revision as of 21:14, 1 January 2018

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

Instrumentation of the gastrointestinal tract includes upper endoscopy, sigmoidoscopy, colonoscopy [10,11], stent placement [10,11], endoscopic sclerotherapy [12], nasogastric intubation [13], esophageal dilation, and surgery.
The area of the esophagus at most risk for instrumental perforation is Killian's triangle [18], 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. [24-31].
Immunosuppressed individuals may be at increased risk for dehiscence and deep organ space infection following surgery. [32]

Medications: Aspirin, potassium supplements, disease-modifying antirheumatic drugs (DMARDs), and nonsteroidal anti-inflammatory drug (NSAID) use has been associated with perforation of colonic diverticula, with diclofenac and ibuprofen being the most commonly implicated drugs. 43 48, 44
Foreign bodies such as sharp objects, food with sharp surfaces, or gastric bezoar. 34-37

Violent retching can lead to spontaneous esophageal perforation, known as Boerhaave syndrome due to increased intraesophageal pressure in the lower esophagus. [51]

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, possibly related to delays in diagnosis [121].

Perforation of the small intestine can be related to bowel obstruction, acute mesenteric ischemia, inflammatory bowel disease [53], or due to iatrogenic or noniatrogenic traumatic mechanisms.
Abdominal wall, groin, diaphragmatic, internal hernia, paraesophageal hernia, and volvulus can all lead to perforation either related to bowel wall ischemia from strangulation, or pressure necrosis.
Injuries to the small intestine during laparoscopic procedures are often not recognized during the procedure. [22]
Croh'n disease has a propensity to perforate slowly, leading to formation of entero-enteric or enterocutaneous fistula formation. [52,53]

Diseases such as typhoid, tuberculosis, or schistosomiasis can perforate the small intestine. The perforations usually occur in the ileum at necrotic Peyer's patches. A reperforation rate of 21.3 percent has been reported for typhoid perforation closure. [136] [61]

Colonic diverticulosis is common in the developed world. These diverticula 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. [59]
Neoplasms can perforate by direct penetration and necrosis, or by producing obstruction. [64-66

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