Gastrointestinal perforation causes: Difference between revisions
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*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. | *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]. | *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] | *[[Immunosuppressed]] individuals may be at increased risk for dehiscence and deep organ space infection following surgery. [32] | ||
=====Other causes===== | =====Other causes===== | ||
*Medications: | *Medications: [[aspirin]], [[potassium]], [[Disease-modifying antirheumatic drug|disease-modifying antirheumatic drugs]], and [[non-steroidal anti-inflammatory drug]] use has been associated with perforation. 43 48, 44 | ||
*Foreign bodies such as sharp objects, food with sharp surfaces, or gastric bezoar. 34-37 | *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] | *Violent retching can lead to spontaneous esophageal perforation, known as [[Boerhaave syndrome]] due to increased intraesophageal pressure in the lower esophagus. [51] | ||
====='''Gastric causes'''===== | ====='''Gastric causes'''===== | ||
*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. [121]. | ||
====='''Small intestine causes'''===== | ====='''Small intestine causes'''===== | ||
*Perforation of the small intestine can be related to bowel obstruction, acute mesenteric ischemia, inflammatory bowel disease [53] | *Perforation of the [[small intestine]] can be related to [[bowel obstruction]], [[acute mesenteric ischemia]], [[inflammatory bowel disease]]. [53] | ||
*Abdominal wall, groin, 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. [22] | *Injuries to the small intestine during laparoscopic procedures are often not recognized during the procedure. [22] | ||
* | *[[Crohn's 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 | *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]]. [136] [61] | |||
=====Large intestine causes===== | =====Large intestine causes===== | ||
*Colonic diverticulosis is common in the developed world. | *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. [59] | *[[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. | *[[Neoplasm|Neoplasms]] can perforate by direct penetration and [[necrosis]], or by producing obstruction. 64-66 | ||
=== Causes of spontaneous intestinal perforation in adults: === | === Causes of spontaneous intestinal perforation in adults: === | ||
* Crohn’s disease | * [[Crohn's disease|Crohn’s disease]] | ||
* Celiac disease | * [[Celiac disease]] | ||
* Graft-''vs''-host disease | * [[Graft-versus-host disease|Graft-''vs''-host disease]] | ||
* Infections: | * Infections: | ||
* Viral: Cytomegalovirus | * Viral: [[Cytomegalovirus]] | ||
* Bacteria: Salmonella paratyphi, mycobacterium tuberculosis | * Bacteria: [[Salmonella paratyphi]], [[mycobacterium tuberculosis]] | ||
* Parasites: Ascaris lumbricoides | * Parasites: [[Ascaris lumbricoides]] | ||
* Protozoa: Entameba histolytica | * Protozoa: [[Amoebiasis|Entameba histolytica]] | ||
* Drugs: NSAIDs and indomethacin | * Drugs: [[Non-steroidal anti-inflammatory drug|NSAIDs]] and [[indomethacin]] | ||
* Enteric-coated potassium chloride | * Enteric-coated [[Potassium chlorate|potassium chloride]] | ||
* Monoclonal antibodies: Bevicuzimab | * [[Monoclonal antibodies]]: Bevicuzimab | ||
* Meckel’s diverticulum | * [[Meckel's diverticulum|Meckel’s diverticulum]] | ||
* Radiation-induced vascular injury | * Radiation-induced vascular injury | ||
* Atherosclerotic vascular occlusion | * Atherosclerotic vascular occlusion | ||
* Buerger’s disease | * [[Buergers disease|Buerger’s disease]] | ||
* Giant cell arteritis | * [[Giant cell arteritis]] | ||
* Wegener’s granulomatosis | * [[Wegener's granulomatosis|Wegener’s granulomatosis]] | ||
* Henoch-schonlein purpura | * [[Henoch-Schönlein purpura|Henoch-schonlein purpura]] | ||
* Allergic granulomatous arteritis | * Allergic granulomatous arteritis | ||
=== Causes of intestinal perforation in neonates === | === Causes of intestinal perforation in neonates === | ||
* Necrotising enterocolitis | * [[Necrotising enterocolitis]] | ||
* Spontaneous | * Spontaneous | ||
* Iatrogenic | * [[Iatrogenic]] | ||
* Umbilical | * Umbilical catheterization | ||
* Umbilical cord clamping | * Umbilical cord clamping | ||
* Nasogastric tube | * [[Nasogastric intubation|Nasogastric tube]] | ||
* Obstruction | * [[Obstruction]] | ||
* Ileal atresia | * Ileal atresia | ||
* Gastric volvulus | * [[Gastric volvulus]] | ||
* Gastroschisis | * [[Gastroschisis]] | ||
* Perforated inguinal hernia | * Perforated [[inguinal hernia]] | ||
* Malrotation/midgut volvulus | * Malrotation/[[midgut volvulus]] | ||
* Congenital band | * Congenital band | ||
==References== | ==References== | ||
Revision as of 17:25, 2 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
Causes of gastrointestinal perforation in adults
Instrumentation
- 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]
Other causes
- Medications: aspirin, potassium, disease-modifying antirheumatic drugs, and non-steroidal anti-inflammatory drug use has been associated with perforation. 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]
Gastric causes
- 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. [121].
Small intestine causes
- Perforation of the small intestine can be related to bowel obstruction, acute mesenteric ischemia, inflammatory bowel disease. [53]
- 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. [22]
- Crohn's 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. [136] [61]
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. [59]
- Neoplasms can perforate by direct penetration and necrosis, or by producing obstruction. 64-66
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