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Classification und Treatment Algorithm of Small Bowel Perforations Based on a Ten-Year Retrospective Analysis

Background: Small bowel perforations are a rare diagnosis compared with esophageal, gastric, and colonic perforations. However, small bowel perforations can be fatal if left untreated. A classification of small bowel perforations or treatment recommendations do not exist to date. Methods: A retrospe...

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Detalles Bibliográficos
Autores principales: Onken, Flurina, Senne, Moritz, Königsrainer, Alfred, Wichmann, Dörte
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9572575/
https://www.ncbi.nlm.nih.gov/pubmed/36233616
http://dx.doi.org/10.3390/jcm11195748
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author Onken, Flurina
Senne, Moritz
Königsrainer, Alfred
Wichmann, Dörte
author_facet Onken, Flurina
Senne, Moritz
Königsrainer, Alfred
Wichmann, Dörte
author_sort Onken, Flurina
collection PubMed
description Background: Small bowel perforations are a rare diagnosis compared with esophageal, gastric, and colonic perforations. However, small bowel perforations can be fatal if left untreated. A classification of small bowel perforations or treatment recommendations do not exist to date. Methods: A retrospective, monocentric, code-related data analysis of patients with small bowel perforations was performed for the period of 2010 to 2019. Results: Over a 10-year period, 267 cases of small bowel perforation in 257 patients (50.2% male and 49.8% female; mean age of 60.28 years) were documented. Perforation’s localization was 5% duodenal, 38% jejunal, 39% ileal, and 18% undocumented. Eight etiologies were differentiated: iatrogenic (41.9%), ischemic (20.6%), malignant (18.9%), inflammatory (8.2%), diverticula-associated (4.5%), traumatic (4.5%), foreign-body-associated (1.9%), and cryptical (1.5%) perforations. Operative treatment combined with antibiotics was the most commonly used therapeutic approach (94.3%). The mortality rate was 14.23%, with highest rate for patients with ischemic perforations. Discussion: An algorithm for diagnostic and therapeutic steps was established. Furthermore, it was found that small bowel perforations are rare events with poor outcomes. Time to diagnosis and grade of underlying disease are the most essential parameters to predict perforation-associated complications.
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spelling pubmed-95725752022-10-17 Classification und Treatment Algorithm of Small Bowel Perforations Based on a Ten-Year Retrospective Analysis Onken, Flurina Senne, Moritz Königsrainer, Alfred Wichmann, Dörte J Clin Med Article Background: Small bowel perforations are a rare diagnosis compared with esophageal, gastric, and colonic perforations. However, small bowel perforations can be fatal if left untreated. A classification of small bowel perforations or treatment recommendations do not exist to date. Methods: A retrospective, monocentric, code-related data analysis of patients with small bowel perforations was performed for the period of 2010 to 2019. Results: Over a 10-year period, 267 cases of small bowel perforation in 257 patients (50.2% male and 49.8% female; mean age of 60.28 years) were documented. Perforation’s localization was 5% duodenal, 38% jejunal, 39% ileal, and 18% undocumented. Eight etiologies were differentiated: iatrogenic (41.9%), ischemic (20.6%), malignant (18.9%), inflammatory (8.2%), diverticula-associated (4.5%), traumatic (4.5%), foreign-body-associated (1.9%), and cryptical (1.5%) perforations. Operative treatment combined with antibiotics was the most commonly used therapeutic approach (94.3%). The mortality rate was 14.23%, with highest rate for patients with ischemic perforations. Discussion: An algorithm for diagnostic and therapeutic steps was established. Furthermore, it was found that small bowel perforations are rare events with poor outcomes. Time to diagnosis and grade of underlying disease are the most essential parameters to predict perforation-associated complications. MDPI 2022-09-28 /pmc/articles/PMC9572575/ /pubmed/36233616 http://dx.doi.org/10.3390/jcm11195748 Text en © 2022 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Onken, Flurina
Senne, Moritz
Königsrainer, Alfred
Wichmann, Dörte
Classification und Treatment Algorithm of Small Bowel Perforations Based on a Ten-Year Retrospective Analysis
title Classification und Treatment Algorithm of Small Bowel Perforations Based on a Ten-Year Retrospective Analysis
title_full Classification und Treatment Algorithm of Small Bowel Perforations Based on a Ten-Year Retrospective Analysis
title_fullStr Classification und Treatment Algorithm of Small Bowel Perforations Based on a Ten-Year Retrospective Analysis
title_full_unstemmed Classification und Treatment Algorithm of Small Bowel Perforations Based on a Ten-Year Retrospective Analysis
title_short Classification und Treatment Algorithm of Small Bowel Perforations Based on a Ten-Year Retrospective Analysis
title_sort classification und treatment algorithm of small bowel perforations based on a ten-year retrospective analysis
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9572575/
https://www.ncbi.nlm.nih.gov/pubmed/36233616
http://dx.doi.org/10.3390/jcm11195748
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