Gastrointestinal perforation overview
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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Gastrointestinal perforation Microchapters |
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Differentiating gastrointestinal perforation from other diseases |
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Diagnosis |
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Treatment |
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Case Studies |
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Gastrointestinal perforation overview On the Web |
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American Roentgen Ray Society Images of Gastrointestinal perforation overview |
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Risk calculators and risk factors for Gastrointestinal perforation overview |
Overview
Surgery
Surgery is the mainstay therapy for gastrointestinal tract (GIT) perforation. The main indications are abdominal sepsis, worsening abdominal pain, signs of diffuse peritonitis, complete bowel obstruction, bowel ischemia. In esophageal perforation, surgical options include primary repair, repair over a drain. Primary repair is the best procedure for thoracic esophageal rupture. It is performed when the closure can heal. Endoscopically-placed-stents can be used to manage some patients with esophageal perforation. In perforated stomach, if the patient is unstable or deteriorating, urgent operation and closure with a piece of omentum is the standard of care. If the patient is stable or improving, nonoperative management with close monitoring is a reasonable option. If patients did not show clinical improvement after 24 hours, surgery was performed. In colonic resection, A one-stage colon resection for diverticulitis can be performed open or laparoscopically. The laparoscopic approach is preferred when feasible. A two-stage procedure is primarily used for patients with Hinchey III or IV diverticulitis, and for those with Hinchey I or II diverticulitis who have excessive contamination or inflammation of the surrounding tissues or other risk factors for anastomotic leakage. In perforated appendix, stable patients with perforated appendicitis who have symptoms localized to the right lower quadrant can be treated with immediate appendectomy or initial nonoperative management. Patients with an appendiceal abscess should be treated with intravenous antibiotics and percutaneous image-guided drainage. For patients who are septic or unstable, and for those who have a free perforation of the appendix or generalized peritonitis, emergency appendectomy is required.