Gastrointestinal perforation Flashcards
Define gastrointestinal perforation
Perforation of the wall of the GI tract w/ spillage of bowel contents
Locations of gastrointestinal perforations
3 + 1 rare
Large bowel
Gastroduodenal
Oesophageal
Small bowel
Aetiology of gastrointestinal perforations - large bowel
3 common, 2 other
Common:
Diverticulitis
Colorectal cancer
Appendicitis
Others:
Volvulus
Ulcerative colitis (toxic megacolon)
Aetiology of gastrointestinal perforations - gastroduodenal
1 common, 1 other
Common:
Perforated duodenal or gastric ulcer
Others:
Gastric cancer
Aetiology of gastrointestinal perforations - small bowel
3
Trauma
Infection (e.g. TB)
Crohn’s disease
Aetiology of gastrointestinal perforations - oesophageal
1
Boerhaave’s perforation
Risk factors for gastroduodenal perforation
3
NSAIDS
Steroids
Bisphosphonates
Epidemiology of gastrointestinal perforation
Incidence depends on cause
Presenting symptoms of gastrointestinal perforation - large bowel
(1 + important)
Peritonitic abdo pain
IMPORTANT to rule our ruptured AAA
Presenting symptoms of gastrointestinal perforation - gastroduodenal
(3)
Sudden onset severe epigastric pain - worse on movement
Pain becomes generalised
Gastric malignancy may have accompanying weight loss & N/V
Presenting symptoms of gastrointestinal perforation - oesophageal
(2)
Severe pain following episode of violent vomiting
Neck/chest pain & dysphagia develop soon after
Signs of gastrointestinal perforation on examination
7
Very UNWELL Signs of shock Pyrexia Pallor Dehydration Signs of peritonitis Loss of liver dullness
Investigations for gastrointestinal perforation
4
Bloods
Erect CXR
AXR
Gastrograffin swallow
Investigations for gastrointestinal perforation - bloods
4
FBC
U&Es
LFTs
Amylase - raised w/ perforation but not astronomical
Investigations for gastrointestinal perforation - erect CXR
1
Shows air under diaphragm
Investigations for gastrointestinal perforation - AXR
1
Shows abnormal gas shadowing
Investigations for gastrointestinal perforation - gastrograffin swallow
(1)
For suspected oesophageal perforations
Branches of management of gastrointestinal perforation
2
Resuscitation
Surgery
Management of gastrointestinal perforation - resuscitation
2
Correct fluid & electrolytes IV antibiotics (w/ anaerobic cover)
Management of gastrointestinal perforation - surgery
3 large bowel, 5 gastroduodenal, 2 oesophageal
Identify site of perforation
Peritoneal lavage
Resection of perforated section (usually part of Hartmann’s procedure)
Gastroduodenal Laparotomy Peritoneal lavage Perforation closed w/ omental patch Gastric ulcers biopsied H. pylori eradication if positive
Oesophageal
Pleural lavage
Repair of ruptured oesophagus
Complications of gastrointestinal perforation
1 large/small bowel, 4 oesophageal
Large & small bowel - peritonitis
Oesophagus - mediastinitis, shock, overwhelming sepsis & death
Prognosis of gastrointestinal perforation
2 gastroduodenal, 2 large bowel
Gastroduodenal
Gastric ulcers have higher morbidity & mortality than duodenal
POOR prognosis for perforated gastric carcinomas
Large bowel
High risk of faecal peritonitis if left untreated
Can lead to DEATH from septicaemia & multi organ failure
