Gastrointestinal perforation causes
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Mohammed Abdelwahed M.D[2]
|
Gastrointestinal perforation Microchapters |
|
Differentiating gastrointestinal perforation from other diseases |
|---|
|
Diagnosis |
|
Treatment |
|
Case Studies |
|
Gastrointestinal perforation causes On the Web |
|
American Roentgen Ray Society Images of Gastrointestinal perforation causes |
|
Risk calculators and risk factors for Gastrointestinal perforation causes |
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[10]
- 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[11]
- Enteric-coated potassium chloride
- Monoclonal antibodies: Bevacizumab
- 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.
- ↑ Gordon PV, Young ML, Marshall DD (2001). "Focal small bowel perforation: an adverse effect of early postnatal dexamethasone therapy in extremely low birth weight infants". J Perinatol. 21 (3): 156–60. doi:10.1038/sj.jp.7200520. PMID 11503101.
- ↑ Stavel M, Wong J, Cieslak Z, Sherlock R, Claveau M, Shah PS (2017). "Effect of prophylactic indomethacin administration and early feeding on spontaneous intestinal perforation in extremely low-birth-weight infants". J Perinatol. 37 (2): 188–193. doi:10.1038/jp.2016.196. PMID 27763630.