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{{Gastrointestinal perforation}}
{{Gastrointestinal perforation}}


==Overview==
==Overview==
Gastrointestinal perforation may be classified based upon the [[etiology]] into instrumental perforation, perforation due to [[systemic diseases]], perforation due to [[inflammatory]] causes, [[medications]] and [[neoplasms]]. Gastrointestinal perforation may also be divided based on age of the patient into adult type and neonatal type perforation.


==Gastrointestinal perforation classification==
==Gastrointestinal perforation classification==
There is no specific classification for gastrointestinal perforation but it can be classified by cause and by age of the patients.


==== Gastrointestinal perforation can be classified by causes into: ====
=== Classification based on etiology: ===


===== Instrumental: =====
===== Instrumental: =====
* Instrumentation of the gastrointestinal tract includes upper endoscopy, sigmoidoscopy, colonoscopy, stent placement, endoscopic sclerotherapy, nasogastric intubation, esophageal dilation, and surgery.
* Instrumentation of the gastrointestinal tract includes [[upper endoscopy]], [[sigmoidoscopy]], [[colonoscopy]], [[stent]] placement, [[Sclerotherapy|endoscopic sclerotherapy]], [[nasogastric intubation]], [[esophageal]] dilation, and [[surgery]]. All of these procedures carry risk of gastrointestinal perforation.<ref name="pmid21778877">{{cite journal |vauthors=Raju GS |title=Gastrointestinal perforations: role of endoscopic closure |journal=Curr. Opin. Gastroenterol. |volume=27 |issue=5 |pages=418–22 |date=September 2011 |pmid=21778877 |doi=10.1097/MOG.0b013e328349e452 |url=}}</ref><ref name="pmid22035338">{{cite journal |vauthors=Søreide JA, Viste A |title=Esophageal perforation: diagnostic work-up and clinical decision-making in the first 24 hours |journal=Scand J Trauma Resusc Emerg Med |volume=19 |issue= |pages=66 |date=October 2011 |pmid=22035338 |pmc=3219576 |doi=10.1186/1757-7241-19-66 |url=}}</ref>
* The area of the esophagus at most risk for instrumental perforation is Killian's triangle, which is the part of the pharynx formed by the inferior pharyngeal constrictor and cricopharyngeus muscle.
* The area of the [[esophagus]] at most risk for instrumental perforation is [[Killian's dehiscence|Killian's triangle]], which is the part of the [[pharynx]] formed by the [[inferior pharyngeal constrictor]] and [[cricopharyngeus muscle]].
* Gastrointestinal leakage can also occur postoperatively as a result of anastomotic breakdown.
* [[Gastrointestinal]] leakage can also occur postoperatively as a result of [[anastomotic]] breakdown.<ref name="pmid16373792">{{cite journal |vauthors=Smith D, Woolley S |title=Hypopharyngeal perforation following minor trauma: a case report and literature review |journal=Emerg Med J |volume=23 |issue=1 |pages=e7 |date=January 2006 |pmid=16373792 |pmc=2564152 |doi=10.1136/emj.2003.012187 |url=}}</ref>
* [[Immunosuppressed]] individuals may be at increased risk for dehiscence and deep organ space infection following surgery.  
* [[Immunosuppressed]] individuals may be at increased risk for perforation and deep organ space [[infection]] following [[Surgery operation|surgery]].<ref name="pmid998862">{{cite journal |vauthors=Matolo NM, Garfinkle SE, Wolfman EF |title=Intestinal necrosis and perforation in patients receiving immunosuppressive drugs |journal=Am. J. Surg. |volume=132 |issue=6 |pages=753–4 |date=December 1976 |pmid=998862 |doi= |url=}}</ref><ref name="pmid18675082">{{cite journal |vauthors=Catena F, Ansaloni L, Gazzotti F, Bertelli R, Severi S, Coccolini F, Fuga G, Nardo B, D'Alessandro L, Faenza A, Pinna AD |title=Gastrointestinal perforations following kidney transplantation |journal=Transplant. Proc. |volume=40 |issue=6 |pages=1895–6 |date=2008 |pmid=18675082 |doi=10.1016/j.transproceed.2008.06.007 |url=}}</ref>


===== Iatrogenic: =====
===== Systemic: =====
* [[Crohn's disease|Crohn’s disease]]
* [[Crohn's disease|Crohn’s disease]]<ref name="pmid16505755">{{cite journal |vauthors=Brihier H, Nion-Larmurier I, Afchain P, Tiret E, Beaugerie L, Gendre JP, Cosnes J |title=Intestinal perforation in Crohn's disease. Factors predictive of surgical resection |journal=Gastroenterol. Clin. Biol. |volume=29 |issue=11 |pages=1105–11 |date=November 2005 |pmid=16505755 |doi= |url=}}</ref>
* [[Celiac disease]]
* [[Celiac disease]]<ref name="pmid25110427">{{cite journal |vauthors=Freeman HJ |title=Spontaneous free perforation of the small intestine in adults |journal=World J. Gastroenterol. |volume=20 |issue=29 |pages=9990–7 |date=August 2014 |pmid=25110427 |pmc=4123378 |doi=10.3748/wjg.v20.i29.9990 |url=}}</ref>
* [[Graft-versus-host disease|Graft-''vs''-host disease]]
* [[Graft-versus-host disease|Graft-''vs''-host disease]]<ref name="pmid23101995">{{cite journal |vauthors=Palaniappa NC, Doyon L, Divino CM |title=Colonic perforation in graft versus host disease: a case report |journal=Int Surg |volume=97 |issue=1 |pages=14–6 |date=2012 |pmid=23101995 |pmc=3723188 |doi=10.9738/CC76.1 |url=}}</ref>
* Infections:
* Infections:
* Viral: [[Cytomegalovirus]]
* Viral: [[Cytomegalovirus]]<ref name="pmid2173658">{{cite journal |vauthors=Kram HB, Shoemaker WC |title=Intestinal perforation due to cytomegalovirus infection in patients with AIDS |journal=Dis. Colon Rectum |volume=33 |issue=12 |pages=1037–40 |date=December 1990 |pmid=2173658 |doi= |url=}}</ref>
* Bacteria: [[Salmonella paratyphi]], [[mycobacterium tuberculosis]]
* Bacteria: [[Salmonella paratyphi]], [[mycobacterium tuberculosis]]<ref name="pmid10695758">{{cite journal |vauthors=Stoner MC, Forsythe R, Mills AS, Ivatury RR, Broderick TJ |title=Intestinal perforation secondary to Salmonella typhi: case report and review of the literature |journal=Am Surg |volume=66 |issue=2 |pages=219–22 |date=February 2000 |pmid=10695758 |doi= |url=}}</ref><ref name="pmid22696633">{{cite journal |vauthors=Dunne JA, Wilson J, Gokhale J |title=Small bowel perforation secondary to enteric Salmonella paratyphi A infection |journal=BMJ Case Rep |volume=2011 |issue= |pages= |date=April 2011 |pmid=22696633 |pmc=3082069 |doi=10.1136/bcr.08.2010.3272 |url=}}</ref><ref name="pmid21341138">{{cite journal |vauthors=Coccolini F, Ansaloni L, Catena F, Lazzareschi D, Puviani L, Pinna AD |title=Tubercular bowel perforation: what to do? |journal=Ulus Travma Acil Cerrahi Derg |volume=17 |issue=1 |pages=66–74 |date=January 2011 |pmid=21341138 |doi= |url=}}</ref><ref name="pmid15797233">{{cite journal |vauthors=Ara C, Sogutlu G, Yildiz R, Kocak O, Isik B, Yilmaz S, Kirimlioglu V |title=Spontaneous small bowel perforations due to intestinal tuberculosis should not be repaired by simple closure |journal=J. Gastrointest. Surg. |volume=9 |issue=4 |pages=514–7 |date=April 2005 |pmid=15797233 |doi=10.1016/j.gassur.2004.09.034 |url=}}</ref>
* Parasites: [[Ascaris lumbricoides]]
* Parasites: [[Ascaris lumbricoides]]<ref name="pmid22869977">{{cite journal |vauthors=Ramareddy RS, Alladi A, Siddapa OS, Deepti V, Akthar T, Mamata B |title=Surgical complications of Ascaris lumbricoides in children |journal=J Indian Assoc Pediatr Surg |volume=17 |issue=3 |pages=116–9 |date=July 2012 |pmid=22869977 |pmc=3409899 |doi=10.4103/0971-9261.98130 |url=}}</ref>
* Protozoa: [[Amoebiasis|Entameba histolytica]]
* Protozoa: [[Amoebiasis|Entameba histolytica]]<ref name="pmid10756002">{{cite journal |vauthors=Espinosa-Cantellano M, Martínez-Palomo A |title=Pathogenesis of intestinal amebiasis: from molecules to disease |journal=Clin. Microbiol. Rev. |volume=13 |issue=2 |pages=318–31 |date=April 2000 |pmid=10756002 |pmc=100155 |doi= |url=}}</ref>
* Drugs: [[Non-steroidal anti-inflammatory drug|NSAIDs]] and [[indomethacin]]
* Drugs: [[Non-steroidal anti-inflammatory drug|NSAIDs]] and [[indomethacin]]<ref name="pmid24267289">{{cite journal |vauthors=Sostres C, Gargallo CJ, Lanas A |title=Nonsteroidal anti-inflammatory drugs and upper and lower gastrointestinal mucosal damage |journal=Arthritis Res. Ther. |volume=15 Suppl 3 |issue= |pages=S3 |date=2013 |pmid=24267289 |pmc=3890944 |doi=10.1186/ar4175 |url=}}</ref><ref name="pmid22253945">{{cite journal |vauthors=Al-Saeed A |title=Gastrointestinal and Cardiovascular Risk of Nonsteroidal Anti-inflammatory Drugs |journal=Oman Med J |volume=26 |issue=6 |pages=385–91 |date=November 2011 |pmid=22253945 |pmc=3251190 |doi=10.5001/omj.2011.101 |url=}}</ref>
* Enteric-coated [[Potassium chlorate|potassium chloride]]
* Enteric-coated [[Potassium chlorate|potassium chloride]]<ref name="pmid6127542">{{cite journal |vauthors=McMahon FG, Ryan JR, Akdamar K, Ertan A |title=Upper gastrointestinal lesions after potassium chloride supplements: a controlled clinical trial |journal=Lancet |volume=2 |issue=8307 |pages=1059–61 |date=November 1982 |pmid=6127542 |doi= |url=}}</ref><ref name="pmid1148734">{{cite journal |vauthors=Farquharson-Roberts MA, Giddings AE, Nunn AJ |title=Perforation of small bowel due to slow release potassium chloride (slow-K) |journal=Br Med J |volume=3 |issue=5977 |pages=206 |date=July 1975 |pmid=1148734 |pmc=1674080 |doi= |url=}}</ref>
* [[Monoclonal antibodies]]: [[Bevacizumab]]
* [[Monoclonal antibodies]]: [[Bevacizumab]]<ref name="pmid17198092">{{cite journal |vauthors=Smith FO, Goff SL, Klapper JA, Levy C, Allen T, Mavroukakis SA, Rosenberg SA |title=Risk of bowel perforation in patients receiving interleukin-2 after therapy with anti-CTLA 4 monoclonal antibody |journal=J. Immunother. |volume=30 |issue=1 |pages=130 |date=January 2007 |pmid=17198092 |pmc=2151199 |doi=10.1097/01.cji.0000211334.06762.89 |url=}}</ref>
* [[Meckel's diverticulum|Meckel’s diverticulum]]
* [[Meckel's diverticulum|Meckel’s diverticulum]]<ref name="pmid26175810">{{cite journal |vauthors=Farah RH, Avala P, Khaiz D, Bensardi F, Elhattabi K, Lefriyekh R, Berrada S, Fadil A, Zerouali NO |title=Spontaneous perforation of Meckel's diverticulum: a case report and review of literature |journal=Pan Afr Med J |volume=20 |issue= |pages=319 |date=2015 |pmid=26175810 |pmc=4491457 |doi=10.11604/pamj.2015.20.319.5980 |url=}}</ref><ref name="pmid21373322">{{cite journal |vauthors=Kloss BT, Broton CE, Sullivan AM |title=Perforated Meckel diverticulum |journal=Int J Emerg Med |volume=3 |issue=4 |pages=455–7 |date=August 2010 |pmid=21373322 |pmc=3047846 |doi=10.1007/s12245-010-0213-9 |url=}}</ref>


===== Inflammatory =====
===== Inflammatory =====
* [[Crohn's disease]] has a propensity to perforate slowly, leading to formation of entero-enteric or enterocutaneous [[fistula]] formation.
* [[Crohn's disease]] has a propensity to perforate slowly, leading to the formation of entero-enteric or [[Enterocutaneous Fistulas|enterocutaneous fistula]]<ref name="pmid16505755">{{cite journal |vauthors=Brihier H, Nion-Larmurier I, Afchain P, Tiret E, Beaugerie L, Gendre JP, Cosnes J |title=Intestinal perforation in Crohn's disease. Factors predictive of surgical resection |journal=Gastroenterol. Clin. Biol. |volume=29 |issue=11 |pages=1105–11 |date=November 2005 |pmid=16505755 |doi= |url=}}</ref>
 
* Diseases such as [[Typhoid fever|typhoid]], [[tuberculosis]], or [[schistosomiasis]] can perforate the [[small intestine]].<ref name="pmid25759563">{{cite journal |vauthors=Xiang JJ, Cheng BJ, Tian F, Li M, Jiang XF, Zhao HC, Hu XM, Xiao BL, Xie JP, Shrestha A |title=Perforation of small bowel caused by Schistosoma japonicum: a case report |journal=World J. Gastroenterol. |volume=21 |issue=9 |pages=2862–4 |date=March 2015 |pmid=25759563 |pmc=4351245 |doi=10.3748/wjg.v21.i9.2862 |url=}}</ref><ref name="pmid10695221">{{cite journal |vauthors=Wu TS, Chen TC, Chen RJ, Chiang PC, Leu HS |title=Schistosoma japonicum infection presenting with colon perforation: case report |journal=Changgeng Yi Xue Za Zhi |volume=22 |issue=4 |pages=676–81 |date=December 1999 |pmid=10695221 |doi= |url=}}</ref>
* Diseases such as [[Typhoid fever|typhoid]], [[tuberculosis]], or [[schistosomiasis]] can perforate the small intestine.
* The perforations usually occur in the [[ileum]] at [[necrotic]] [[Peyer's patches]].<ref name="pmid24349848">{{cite journal |vauthors=Sharma A, Sharma R, Sharma S, Sharma A, Soni D |title=Typhoid intestinal perforation: 24 perforations in one patient |journal=Ann Med Health Sci Res |volume=3 |issue=Suppl 1 |pages=S41–3 |date=November 2013 |pmid=24349848 |pmc=3853607 |doi=10.4103/2141-9248.121220 |url=}}</ref>
* The perforations usually occur in the ileum at necrotic [[Peyer's patches]].


===== Medication =====
===== Medication =====
* [[Aspirin]], [[potassium]], [[Disease-modifying antirheumatic drug|disease-modifying antirheumatic drugs]], and [[non-steroidal anti-inflammatory drug]] use has been associated with perforation.
* [[Aspirin]], [[potassium]], [[Disease-modifying antirheumatic drug|disease-modifying antirheumatic drugs]], and [[non-steroidal anti-inflammatory drug]] use have been associated with perforation.<ref name="pmid27213279">{{cite journal |vauthors=Xie F, Yun H, Bernatsky S, Curtis JR |title=Brief Report: Risk of Gastrointestinal Perforation Among Rheumatoid Arthritis Patients Receiving Tofacitinib, Tocilizumab, or Other Biologic Treatments |journal=Arthritis Rheumatol |volume=68 |issue=11 |pages=2612–2617 |date=November 2016 |pmid=27213279 |pmc=5538140 |doi=10.1002/art.39761 |url=}}</ref><ref name="pmid9041228">{{cite journal |vauthors=Lanas A, Serrano P, Bajador E, Esteva F, Benito R, Sáinz R |title=Evidence of aspirin use in both upper and lower gastrointestinal perforation |journal=Gastroenterology |volume=112 |issue=3 |pages=683–9 |date=March 1997 |pmid=9041228 |doi= |url=}}</ref>


===== Neoplasm =====
===== Neoplasm =====
* [[Neoplasm|Neoplasms]] can perforate by direct penetration and [[necrosis]], or by producing obstruction.
* [[Neoplasm|Neoplasms]] can perforate by direct penetration and [[necrosis]], or by producing obstruction.


==== Gastrointestinal perforation can be classified by age into: ====
=== Classification based on age: ===
*Adult-type gastrointestinal perforation
*Adult-type gastrointestinal perforation
*Neonatal gastrointestinal perforation:  
*Neonatal gastrointestinal perforation:<ref name="pmid23031751">{{cite journal |vauthors=Daliya P, White TJ, Makhdoomi KR |title=Gastric perforation in an adult male following nasogastric intubation |journal=Ann R Coll Surg Engl |volume=94 |issue=7 |pages=e210–2 |date=October 2012 |pmid=23031751 |pmc=3954270 |doi=10.1308/003588412X13171221502347 |url=}}</ref><ref name="pmid26023450">{{cite journal |vauthors=Hyginus EO, Jideoffor U, Victor M, N OA |title=Gastrointestinal perforation in neonates: aetiology and risk factors |journal=J Neonatal Surg |volume=2 |issue=3 |pages=30 |date=2013 |pmid=26023450 |pmc=4422271 |doi= |url=}}</ref>
**[[Necrotising enterocolitis]]
**[[Necrotising enterocolitis]]
**Spontaneous
**Spontaneous
Line 51: Line 53:
**[[Nasogastric intubation|Nasogastric tube]]
**[[Nasogastric intubation|Nasogastric tube]]
**[[Obstruction]]
**[[Obstruction]]
**Ileal [[atresia]]
**[[Ileum|Ileal]] [[atresia]]
**[[Gastric volvulus]]
**[[Gastric volvulus]]
**[[Gastroschisis]]
**[[Gastroschisis]]

Latest revision as of 20:17, 1 March 2018


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

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Overview

Gastrointestinal perforation may be classified based upon the etiology into instrumental perforation, perforation due to systemic diseases, perforation due to inflammatory causes, medications and neoplasms. Gastrointestinal perforation may also be divided based on age of the patient into adult type and neonatal type perforation.

Gastrointestinal perforation classification

There is no specific classification for gastrointestinal perforation but it can be classified by cause and by age of the patients.

Classification based on etiology:

Instrumental:
Systemic:
Inflammatory
Medication
Neoplasm
  • Neoplasms can perforate by direct penetration and necrosis, or by producing obstruction.

Classification based on age:

References

  1. ↑ Raju GS (September 2011). "Gastrointestinal perforations: role of endoscopic closure". Curr. Opin. Gastroenterol. 27 (5): 418–22. doi:10.1097/MOG.0b013e328349e452. PMID 21778877.
  2. ↑ Søreide JA, Viste A (October 2011). "Esophageal perforation: diagnostic work-up and clinical decision-making in the first 24 hours". Scand J Trauma Resusc Emerg Med. 19: 66. doi:10.1186/1757-7241-19-66. PMC 3219576. PMID 22035338.
  3. ↑ Smith D, Woolley S (January 2006). "Hypopharyngeal perforation following minor trauma: a case report and literature review". Emerg Med J. 23 (1): e7. doi:10.1136/emj.2003.012187. PMC 2564152. PMID 16373792.
  4. ↑ Matolo NM, Garfinkle SE, Wolfman EF (December 1976). "Intestinal necrosis and perforation in patients receiving immunosuppressive drugs". Am. J. Surg. 132 (6): 753–4. PMID 998862.
  5. ↑ Catena F, Ansaloni L, Gazzotti F, Bertelli R, Severi S, Coccolini F, Fuga G, Nardo B, D'Alessandro L, Faenza A, Pinna AD (2008). "Gastrointestinal perforations following kidney transplantation". Transplant. Proc. 40 (6): 1895–6. doi:10.1016/j.transproceed.2008.06.007. PMID 18675082.
  6. ↑ 6.0 6.1 Brihier H, Nion-Larmurier I, Afchain P, Tiret E, Beaugerie L, Gendre JP, Cosnes J (November 2005). "Intestinal perforation in Crohn's disease. Factors predictive of surgical resection". Gastroenterol. Clin. Biol. 29 (11): 1105–11. PMID 16505755.
  7. ↑ Freeman HJ (August 2014). "Spontaneous free perforation of the small intestine in adults". World J. Gastroenterol. 20 (29): 9990–7. doi:10.3748/wjg.v20.i29.9990. PMC 4123378. PMID 25110427.
  8. ↑ Palaniappa NC, Doyon L, Divino CM (2012). "Colonic perforation in graft versus host disease: a case report". Int Surg. 97 (1): 14–6. doi:10.9738/CC76.1. PMC 3723188. PMID 23101995.
  9. ↑ Kram HB, Shoemaker WC (December 1990). "Intestinal perforation due to cytomegalovirus infection in patients with AIDS". Dis. Colon Rectum. 33 (12): 1037–40. PMID 2173658.
  10. ↑ Stoner MC, Forsythe R, Mills AS, Ivatury RR, Broderick TJ (February 2000). "Intestinal perforation secondary to Salmonella typhi: case report and review of the literature". Am Surg. 66 (2): 219–22. PMID 10695758.
  11. ↑ Dunne JA, Wilson J, Gokhale J (April 2011). "Small bowel perforation secondary to enteric Salmonella paratyphi A infection". BMJ Case Rep. 2011. doi:10.1136/bcr.08.2010.3272. PMC 3082069. PMID 22696633.
  12. ↑ Coccolini F, Ansaloni L, Catena F, Lazzareschi D, Puviani L, Pinna AD (January 2011). "Tubercular bowel perforation: what to do?". Ulus Travma Acil Cerrahi Derg. 17 (1): 66–74. PMID 21341138.
  13. ↑ Ara C, Sogutlu G, Yildiz R, Kocak O, Isik B, Yilmaz S, Kirimlioglu V (April 2005). "Spontaneous small bowel perforations due to intestinal tuberculosis should not be repaired by simple closure". J. Gastrointest. Surg. 9 (4): 514–7. doi:10.1016/j.gassur.2004.09.034. PMID 15797233.
  14. ↑ Ramareddy RS, Alladi A, Siddapa OS, Deepti V, Akthar T, Mamata B (July 2012). "Surgical complications of Ascaris lumbricoides in children". J Indian Assoc Pediatr Surg. 17 (3): 116–9. doi:10.4103/0971-9261.98130. PMC 3409899. PMID 22869977.
  15. ↑ Espinosa-Cantellano M, Martínez-Palomo A (April 2000). "Pathogenesis of intestinal amebiasis: from molecules to disease". Clin. Microbiol. Rev. 13 (2): 318–31. PMC 100155. PMID 10756002.
  16. ↑ Sostres C, Gargallo CJ, Lanas A (2013). "Nonsteroidal anti-inflammatory drugs and upper and lower gastrointestinal mucosal damage". Arthritis Res. Ther. 15 Suppl 3: S3. doi:10.1186/ar4175. PMC 3890944. PMID 24267289.
  17. ↑ Al-Saeed A (November 2011). "Gastrointestinal and Cardiovascular Risk of Nonsteroidal Anti-inflammatory Drugs". Oman Med J. 26 (6): 385–91. doi:10.5001/omj.2011.101. PMC 3251190. PMID 22253945.
  18. ↑ McMahon FG, Ryan JR, Akdamar K, Ertan A (November 1982). "Upper gastrointestinal lesions after potassium chloride supplements: a controlled clinical trial". Lancet. 2 (8307): 1059–61. PMID 6127542.
  19. ↑ Farquharson-Roberts MA, Giddings AE, Nunn AJ (July 1975). "Perforation of small bowel due to slow release potassium chloride (slow-K)". Br Med J. 3 (5977): 206. PMC 1674080. PMID 1148734.
  20. ↑ Smith FO, Goff SL, Klapper JA, Levy C, Allen T, Mavroukakis SA, Rosenberg SA (January 2007). "Risk of bowel perforation in patients receiving interleukin-2 after therapy with anti-CTLA 4 monoclonal antibody". J. Immunother. 30 (1): 130. doi:10.1097/01.cji.0000211334.06762.89. PMC 2151199. PMID 17198092.
  21. ↑ Farah RH, Avala P, Khaiz D, Bensardi F, Elhattabi K, Lefriyekh R, Berrada S, Fadil A, Zerouali NO (2015). "Spontaneous perforation of Meckel's diverticulum: a case report and review of literature". Pan Afr Med J. 20: 319. doi:10.11604/pamj.2015.20.319.5980. PMC 4491457. PMID 26175810.
  22. ↑ Kloss BT, Broton CE, Sullivan AM (August 2010). "Perforated Meckel diverticulum". Int J Emerg Med. 3 (4): 455–7. doi:10.1007/s12245-010-0213-9. PMC 3047846. PMID 21373322.
  23. ↑ Xiang JJ, Cheng BJ, Tian F, Li M, Jiang XF, Zhao HC, Hu XM, Xiao BL, Xie JP, Shrestha A (March 2015). "Perforation of small bowel caused by Schistosoma japonicum: a case report". World J. Gastroenterol. 21 (9): 2862–4. doi:10.3748/wjg.v21.i9.2862. PMC 4351245. PMID 25759563.
  24. ↑ Wu TS, Chen TC, Chen RJ, Chiang PC, Leu HS (December 1999). "Schistosoma japonicum infection presenting with colon perforation: case report". Changgeng Yi Xue Za Zhi. 22 (4): 676–81. PMID 10695221.
  25. ↑ Sharma A, Sharma R, Sharma S, Sharma A, Soni D (November 2013). "Typhoid intestinal perforation: 24 perforations in one patient". Ann Med Health Sci Res. 3 (Suppl 1): S41–3. doi:10.4103/2141-9248.121220. PMC 3853607. PMID 24349848.
  26. ↑ Xie F, Yun H, Bernatsky S, Curtis JR (November 2016). "Brief Report: Risk of Gastrointestinal Perforation Among Rheumatoid Arthritis Patients Receiving Tofacitinib, Tocilizumab, or Other Biologic Treatments". Arthritis Rheumatol. 68 (11): 2612–2617. doi:10.1002/art.39761. PMC 5538140. PMID 27213279.
  27. ↑ Lanas A, Serrano P, Bajador E, Esteva F, Benito R, Sáinz R (March 1997). "Evidence of aspirin use in both upper and lower gastrointestinal perforation". Gastroenterology. 112 (3): 683–9. PMID 9041228.
  28. ↑ Daliya P, White TJ, Makhdoomi KR (October 2012). "Gastric perforation in an adult male following nasogastric intubation". Ann R Coll Surg Engl. 94 (7): e210–2. doi:10.1308/003588412X13171221502347. PMC 3954270. PMID 23031751.
  29. ↑ Hyginus EO, Jideoffor U, Victor M, N OA (2013). "Gastrointestinal perforation in neonates: aetiology and risk factors". J Neonatal Surg. 2 (3): 30. PMC 4422271. PMID 26023450.
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