Gastrointestinal perforation history and symptoms: Difference between revisions

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Latest revision as of 04:40, 4 February 2018

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Mohammed Abdelwahed M.D [2]

Overview

History of recent instrumentation, surgery, or ingested foreign bodies is usually related to gastrointestinal tract (GIT) perforation. Main symptoms are pains in chest or abdomen, abdominal mass, dysphagia, fistula formation, or sepsis. Diverticulitis is the most common etiology leading to intra-abdominal abscess formation. Patients who develop an external fistula will complain of the sudden appearance of drainage from a postoperative wound, or from the abdominal wall or perineum in the case of spontaneous fistulas.

History of GIT perforation

History of recent instrumentation, surgery, or ingested foreign bodies is usually related to gastrointestinal tract perforation.
Medical conditions such as peptic ulcer disease or malignancy may be related to GIT perforation.
History of medications such as nonsteroidal anti-inflammatory drugs or glucocorticoids.

Presentations of GIT perforation

Acute symptoms associated with free perforation depend upon the nature and location of perforation:

Esophageal perforation

Pharyngeal or neck pain: Pain radiating to the shoulder
Odynophagia
Dysphagia

Gastric and intestinal perforation

A sudden release of the gastric acid into the abdomen causes severe and sudden peritoneal irritation and severe pain.^[1]
Abdominal mass
Abscess or phlegmon formation that can be appreciated on examination as an abdominal mass or with abdominal exploration.^[1]
Diverticulitis is the most common etiology leading to intra-abdominal abscess formation.
Fistula formation: Fistulas are often related to inflammatory bowel diseases such as Crohn disease.^[2]
Patients who develop an external fistula will complain of the sudden appearance of drainage from a postoperative wound, or from the abdominal wall or perineum in the case of spontaneous fistulas.^[2]
Sepsis: Sepsis can be the initial presentation of perforation, but its frequency is difficult to determine. Patients appear with hemodynamically unstablility or altered mental status. Organ dysfunction including acute respiratory distress syndrome, acute kidney injury, and disseminated intravascular coagulation may be present.^[3]
Spontaneous intestinal perforation and necrotizing enterocolitis are gastrointestinal complications that typically occur in very low birth weight and extremely low birth weight.^[4]

References

↑ ^1.0 ^1.1 Rami Reddy SR, Cappell MS (2017). "A Systematic Review of the Clinical Presentation, Diagnosis, and Treatment of Small Bowel Obstruction". Curr Gastroenterol Rep. 19 (6): 28. doi:10.1007/s11894-017-0566-9. PMID 28439845.
↑ ^2.0 ^2.1 Devaraj NK (2017). "Letter to the Editor: Colonic Perforation". Acta Med Port. 30 (12): 891. doi:10.20344/amp.9556. PMID 29364805.
↑ Barie PS (2018). "Outcomes of Surgical Sepsis". Surg Infect (Larchmt). doi:10.1089/sur.2018.009. PMID 29394149.
↑ Ylöstalo P, Jouppila P, Kirkinen P (1979). "The use of ultrasound in obstetrics". Ann Clin Res. 11 (5): 222–32. PMID 397802.

[pmid28439845-1] 1.0 ^1.1 Rami Reddy SR, Cappell MS (2017). "A Systematic Review of the Clinical Presentation, Diagnosis, and Treatment of Small Bowel Obstruction". Curr Gastroenterol Rep. 19 (6): 28. doi:10.1007/s11894-017-0566-9. PMID 28439845.

[pmid29364805-2] 2.0 ^2.1 Devaraj NK (2017). "Letter to the Editor: Colonic Perforation". Acta Med Port. 30 (12): 891. doi:10.20344/amp.9556. PMID 29364805.

[pmid29394149-3] Barie PS (2018). "Outcomes of Surgical Sepsis". Surg Infect (Larchmt). doi:10.1089/sur.2018.009. PMID 29394149.

[pmid397802-4] Ylöstalo P, Jouppila P, Kirkinen P (1979). "The use of ultrasound in obstetrics". Ann Clin Res. 11 (5): 222–32. PMID 397802.

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[2]

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@@ Line 5: / Line 5: @@
 ==Overview==
-'''History'''
+History of recent instrumentation, [[surgery]], or ingested foreign bodies is usually related to [[gastrointestinal tract]] (GIT) perforation. Main symptoms are pains in [[chest]] or [[abdomen]], [[abdominal mass]], [[dysphagia]], [[fistula]] formation, or [[sepsis]]. [[Diverticulitis]] is the most common etiology leading to intra-abdominal [[abscess]] formation. Patients who develop an external [[fistula]] will complain of the sudden appearance of drainage from a postoperative wound, or from the abdominal wall or perineum in the case of spontaneous fistulas.
-* The history of prior bouts of abdominal or chest pain, prior instrumentation, surgery, malignancy, or ingested foreign bodies
-* Medical conditions such as peptic disease or medical device implants
-* History of medications such as nonsteroidal anti-inflammatory drugs or glucocorticoids.
-'''Presentations'''
-* Acute pain
-* Sudden severe chest or abdominal pain
+== History of GIT perforation ==
-* Patients on [[Immunosuppressive|immunosuppressives]] or [[Anti-inflammatory medication|anti-inflammatory]] agents may present with an [[abdominal mass]] reflecting [[abscess]] formation, or [[fistula]] drainage, and some may present with abdominal sepsis due to impaired inflammatory reaction.
+* History of recent instrumentation, [[surgery]], or ingested foreign bodies is usually related to [[gastrointestinal tract]] perforation.
-Dysphagia
+* Medical conditions such as [[peptic ulcer disease]] or [[malignancy]] may be related to GIT perforation.
+* History of medications such as [[Non-steroidal anti-inflammatory drug|nonsteroidal anti-inflammatory drugs]] or [[glucocorticoids]].
-Acute symptoms associated with free perforation depend upon the nature and location of perforation:
+== Presentations of GIT perforation ==
+* Acute symptoms associated with free perforation depend upon the nature and location of perforation:
-Cervical esophageal perforation
+==== Esophageal perforation ====
+* [[Pharyngeal]] or [[neck pain]]: Pain radiating to the [[shoulder]]
+* [[Odynophagia]]
+* [[Dysphagia]]
-Pharyngeal or neck pain: Pain radiating to the shoulder
+==== Gastric and intestinal perforation ====
+* A sudden release of the [[gastric acid]] into the abdomen causes severe and sudden [[Peritoneum|peritoneal]] irritation and severe pain.<ref name="pmid28439845">{{cite journal| author=Rami Reddy SR, Cappell MS| title=A Systematic Review of the Clinical Presentation, Diagnosis, and Treatment of Small Bowel Obstruction. | journal=Curr Gastroenterol Rep | year= 2017 | volume= 19 | issue= 6 | pages= 28 | pmid=28439845 | doi=10.1007/s11894-017-0566-9 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28439845  }}</ref>
-Odynophagia
+* [[Abdominal mass]]
+* [[Abscess]] or [[phlegmon]] formation that can be appreciated on examination as an [[abdominal mass]] or with abdominal exploration.<ref name="pmid28439845" />
-Dysphagia
+* [[Diverticulitis]] is the most common etiology leading to intra-abdominal [[abscess]] formation.
+* [[Fistula]] formation: [[Fistula|Fistulas]] are often related to [[Inflammatory bowel disease|inflammatory bowel diseases]] such as [[Crohn's disease|Crohn disease]].<ref name="pmid29364805">{{cite journal| author=Devaraj NK| title=Letter to the Editor: Colonic Perforation. | journal=Acta Med Port | year= 2017 | volume= 30 | issue= 12 | pages= 891 | pmid=29364805 | doi=10.20344/amp.9556 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=29364805  }}</ref>
-Because the pH of gastric contents is 1 to 2 along the gastric luminal surface, a sudden release of this acid into the abdomen causes severe and sudden peritoneal irritation and severe pain.
+* Patients who develop an external [[fistula]] will complain of the sudden appearance of drainage from a postoperative wound, or from the abdominal wall or perineum in the case of spontaneous fistulas.<ref name="pmid29364805" />
+* [[Sepsis]]: Sepsis can be the initial presentation of perforation, but its frequency is difficult to determine. Patients appear with hemodynamically unstablility or [[altered mental status]]. Organ dysfunction including [[acute respiratory distress syndrome]], [[acute kidney injury]], and [[disseminated intravascular coagulation]] may be present.<ref name="pmid29394149">{{cite journal| author=Barie PS| title=Outcomes of Surgical Sepsis. | journal=Surg Infect (Larchmt) | year= 2018 | volume=  | issue=  | pages=  | pmid=29394149 | doi=10.1089/sur.2018.009 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=29394149  }}</ref>
-The leakage of small intestinal contents into the peritoneal cavity may also cause severe pain, and for this reason, any severe pain after, particularly, a laparoscopic procedure should cause the surgeon to suspect leakage.
+* Spontaneous intestinal perforation and [[necrotizing enterocolitis]] are gastrointestinal complications that typically occur in very [[low birth weight]] and extremely low birth weight.<ref name="pmid397802">{{cite journal| author=Ylöstalo P, Jouppila P, Kirkinen P| title=The use of ultrasound in obstetrics. | journal=Ann Clin Res | year= 1979 | volume= 11 | issue= 5 | pages= 222-32 | pmid=397802 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=397802  }}</ref>
-Abdominal mass
-It is not uncommon for perforation to lead to abscess or phlegmon formation that can be appreciated on examination as an abdominal mass or with abdominal exploration. Diverticulitis is the most common etiology leading to intra-abdominal abscess formation.
-Fistula formation
-* Fistulas are often related to inflammatory bowel diseases such as Crohn disease.
-* Patients who develop an external fistula will complain of the sudden appearance of drainage from a postoperative wound, or from the abdominal wall or perineum in the case of spontaneous fistulas.
-Sepsis
-* Sepsis can be the initial presentation of perforation, but its frequency is difficult to determine.
-* ill appearing
-* hemodynamically unstable
-* altered mental status
-* Organ dysfunction including acute respiratory distress syndrome, acute kidney injury, and disseminated intravascular coagulation may be present.
-* Spontaneous intestinal perforation and necrotizing enterocolitis are gastrointestinal complications that typically occur in
-* very low birth weight and extremely low birth weight
-* preterm infants with a gestational age between 25 and 27 weeks
-'''Physical findings'''
-Infants with SIP present with an acute onset of abdominal distension and hypotension.
-Abdominal distention usually occurs without the abdominal wall erythema, crepitus, and induration commonly seen in patients with NEC.
-A black-bluish discoloration of the abdominal wall is often seen in SIP, and is not typical of NEC (picture 2) [1,4,27,33,35,36].
-The discoloration may extend into the groin and, in males, the scrotum.
-'''Associated infections'''
-In several case series, concomitant sepsis due to coagulase-negative Staphylococcus or fungemia due to Candida albicans have been reported in neonates with SIP and may be a major cause of morbidity and mortality [1,2,11,33].
-It is unknown whether the infections precede or are a result of bowel perforation.
 ==References==
+{{Reflist|2}}