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Gastrointestinal (GI) perforation is a common surgical emergency with high morbidity and mortality.
Initially, patients often present with sudden abdominal pain, and in severe patients, symptoms of septic shock secondary to peritonitis can occur
.
Small bowel perforations are less common than perforations elsewhere throughout the gastrointestinal tract and often present with atypical clinical manifestations
.
However, small bowel perforations are more prone to serious and even life-threatening infections
.
Mechanical obstruction and immune-mediated disease (Crohn's disease) are the leading causes of small bowel perforation in Western countries, whereas small bowel perforation secondary to typhoid and tuberculosis is more common in developing countries
.
This study retrospectively analyzed ICU patients undergoing emergency surgery for small bowel perforation to investigate prognostic factors associated with postoperative mortality
.
The researchers retrospectively analyzed the clinical data of patients with small bowel perforation who were admitted to the ICU of Fudan University Zhongshan Hospital from February 2011 to May 2020
.
The patient's medical records were analyzed in detail to identify differences in clinical characteristics, laboratory parameters, surgical outcomes, and pathology
.
A total of 104 patients were included in this study, of whom 18 (17.
3%) underwent perforation repair, 59 (56.
7%) underwent segmental resection and primary anastomosis, and 27 (26.
0%) underwent enterostomy
.
Malignancy was the main cause of perforation in these patients (40.
4%, 42/104)
.
The overall postoperative morbidity and mortality were 74.
0% (77/104) and 19.
2% (20/104), respectively
.
Malignancy-related perforation (odds ratio [OR], 4.
659; 95% confidence interval [CI], 1.
269-17.
105; P = 0.
020) and high postoperative arterial lactate levels (OR, 1.
479; 95% CI, 1.
027-2.
131; P=0.
036) was identified as an independent risk factor for postoperative mortality in patients with small bowel perforation transferred to the ICU
.
This study confirms that patients with small bowel perforation who are transferred to the ICU after emergency surgery are at high risk for postoperative complications and death
.
In addition, patients with malignancy-related perforation and higher postoperative blood lactate levels had a poorer prognosis
.
Original source:
Jianzhang Wu.
et al.
Predictors of mortality in patients with acute small-bowel perforation transferred to ICU after emergency surgery: a single-centre retrospective cohort study.
Gastroenterology Report.
2022.