Gastrointestinal perforation epidemiology and demographics
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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Differentiating gastrointestinal perforation from other diseases |
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Overview=
Rates increased with age, and were approximately twice as high in men than in women. Epidemiologic studies based on automated data may slightly under- or overestimate the true incidence rate among nonusers of NSAIDs. Overall, the incidence rate of serious upper gastrointestinal complications was in the order of 1 per 1,000 person-years among nonusers of prescription NSAIDs
The incidence of Colonic perforation could be as low as 0.016% of all diagnostic colonoscopy procedures[6] and may be seen in up to 5% of therapeutic colonoscopies[7,8].
the incidence of CP following flexible sigmoidoscopy varies from 0.027% to 0.088%[1,9-12]. rectal perforation during colonoscopic retroflexion was reported to be around 0.01%[13].
The most common site of colonic perforation is the rectosigmoid colon[1-4,17,19,20].
Several factors making this bowel segment vulnerable to being injured include a sharp angulation at either the rectosigmoid junction or the sigmoid-descending colon junction, and the great mobility of the sigmoid colon. A forceful insertion of an endoscope while having a sigmoid loop formation is the leading cause of anti-mesenteric bowel perforation due to an overextension of bowel by the shaft of the endoscope. Additionally, the sigmoid colon is commonly involved with diverticular formation[17,21], and the muscular layer of the bowel wall may be thin or fragile due to previous inflammation (diverticulitis). Pelvic adhesions following previous pelvic operation or infection also contribute to a high incidence of sigmoid perforation[2,7].
Seventeen esophageal perforations (1.7%) occurred in the course of 1011 procedures. Four perforations resulted from balloon dilatation, and 13 were secondary to bougienage. Six patients were managed surgically (35%), all of them recovering uneventfully. Eleven patients were managed conservatively, mainly because they were unfit for surgery. Survival rate in this group was 82%; only two patients died, both of whom had underlying malignant diseas
We recently reported a 9% incidence of bowel perforation in our cohort of 1062 patients with biopsy-proven GI involvement with lymphoma [1]. Among the 100 perforation events, the small bowel was the most common site of perforation and diffuse large B-cell lymphoma (DLBCL) was the most common histology. The risk of perforation seems to vary by both the site of involvement as well as the type of lymphoma. Herein, we report additional data from the same cohort of patients regarding site-specific incidence of perforation, stratified by lymphoma histology (Table 1). Among the 1062 GI lymphomas in our series, the stomach was the most frequent site of involvement (44%), followed by the colon/rectum (25%), small bowel (24%) and duodenum (7%). The esophagus was the least frequently involved (<1%). Overall, DLBCL was the most frequent histology (39%) and was associated with the highest frequency of perforations (13.2%), whereas mucosa-associated lymphoid tissue (MALT) lymphoma, the next most frequent histology (21%), was associated with a much lower risk of perforation (1.8%). In general, low-grade lymphomas perforated less frequently than their high-grade counterparts, irrespective of the site of involvement