Patient outcomes and prognostic factors associated with colonic perforation surgery: a retrospective study

Abstract

Background: Despite advances in surgery and intensive perioperative care, fecal peritonitis secondary to colonic perforation is associated with high rates of morbidity and mortality. This study was performed to review the outcomes of patients who underwent colonic perforation surgery and to evaluate the prognostic factors associated with mortality. Methods: A retrospective analysis was performed on 224 consecutive patients who underwent emergency colonic perforation surgery between January 2008 and May 2019. We divided the patients into survivor and non-survivor groups and compared their surgical outcomes.Results: The most common cause of colon perforation was malignancy in 54 patients (24.1%), followed by iatrogenic perforation in 41 (18.3%), stercoral perforation in 39 (17.4%), and diverticulitis in 37 (16.5%). The sigmoid colon (n=124, 55.4%) was the most common location of perforation, followed by the ascending colon, rectum, and cecum. Forty-five patients (20.1%) died within 1 month after surgery. Comparing the 179 survivors with the 45 non-survivors, the patient characteristics associated with mortality were advanced age, low systolic blood pressure, tachycardia, organ failure, high C-reactive protein, high creatinine, prolonged prothrombin time, and high lactate level. The presence of free or feculent fluid, diffuse peritonitis, and right-sided perforation were associated with mortality. In multivariate analysis, advanced age, organ failure, right-sided perforation, and diffuse peritonitis independently predicted mortality within 1 month after surgery.Conclusion: Age and organ failure were prognostic factors for mortality associated with colon perforation. Furthermore, right-sided perforation and diffuse peritonitis demonstrated a significant association with patient mortality.

Liên Quan Vị Trí Dịch Ổ Bụng Trên Cắt Lớp Vi Tính Và Biến Chứng Nhiểm Khuẩn Sau Mổ Thủng Dạ Dày Ruột

“…Nghiên cứu chỉ ra rằng điểm APACHE -II, bệnh lý ác tính, nồng độ lactat máu sau phẫu thuật cao (>1,920 mmol/L) có liên quan đến kết quả lâm sàng xấu của BN thủng ruột non.9 Nghiên cứu của Lee và cs về phẫu thuật thủng đại tràng cũng cho thấy tuổi cao và tình trạng suy các tạng, viêm phúc mạc lan tỏa, sự xuất hiện dịch tự do ổ bụng có liên quan đến tỷ lệ tử vong trong vòng 1 tháng sau phẫu thuật. 5 Chúng tôi nhận thấy vị trí phân bố của dịch ổ bụng trên CLVT có liên quan đến nguy cơ nhiễm khuẩn huyết. Dịch ở các vị trí ¼ trên phải có nguy cơ nhiễm khuẩn huyết tăng gấp 5,7 lần, dịch ¼ dưới phải gấp 4,1 lần, dịch ¼ dưới trái gấp 2,3 lần và dịch giữa các quai ruột có nguy cơ xuất hiện nhiễm khuẩn huyết gấp 2,5 lần (p<0,05).…”

Fatores de risco para lesões periestomais em estomas de eliminação: Um protocolo de revisão sistemática e metassíntese

“…Among the skin conditions affecting the peristomal area, the most common is dermatitis, which can be classified as allergic contact dermatitis caused by the device or the products used or chemical dermatitis resulting from leakage and irritation of the skin by the enzymes present in the effluent (2) . However, other types of conditions may also occur, such as pyoderma gangrenosum, erythema, ulceration, candidiasis, folliculitis, varicose veins, pseudoverrucous lesions, psoriasis, and granulomas (8)(9)(10) . It should be noted that several factors contribute to the occurrence of peristomal skin complications, such as inadequate removal and repeated application of the collection device, moisture, improper or absent marking of the implantation site, exposure of the skin to corrosive effluents, infection, allergic reaction, misuse of inappropriate topical products, excessive hygiene, and improper handling and cutting of the collection device (4,11) .…”

“…These factors disrupt the homeostatic balance of the skin and affect the quality of life, well-being, and rehabilitation of ostomy patients (2) . In addition, these complications can interfere with activities of daily living (ADLs), cause difficulties with self-care, discomfort, pain, reduced social interaction, mood changes, additional use of appliances and devices, specific stoma care, and increased healthcare costs (10,12,13) . This study is justified by the opportunity to gain a deeper understanding of the risk factors associated with peristomal skin complications in ostomy patients, as these complications directly impact a patient's quality of life.…”

One Year of Experience Managing Peritonitis Secondary to Gastrointestinal Perforation at a Tertiary Care Hospital: A Retrospective Analysis

“…It causes intestinal tract or free colonic perforations, which is the most frequent condition resulting in surgical emergency worldwide [ 3 ]. The perforations cause a life-threatening condition that calls for emergency surgical attention with high morbidity and mortality rates [ 4 ]. There are improvements in radiologic and surgical interventions for peritonitis, including improved intensive care management.…”

“…However, patients suffering from gastrointestinal perforation-related peritonitis need instant surgical management from highly skilled surgeons in a high-quality surgical unit. Surgical treatment of peritonitis perforation is a highly complex procedure, but the recent improvements in intensive care support and microbial therapy, combined with improved surgical techniques, have resulted in improved patient outcomes [ 4 ]. This paper aims to present one year of experience in the surgical management of patients presented with peritonitis secondary to gastrointestinal perforation in Lahore General Hospital, Lahore, Pakistan.…”