Gastrointestinal perforation classification

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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Gastrointestinal perforation classification

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 dehiscence and deep organ space infection following surgery.

Iatrogenic:

• 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 has been associated with perforation.

Neoplasm

• Neoplasms can perforate by direct penetration and necrosis, or by producing obstruction.

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