Gastrointestinal perforation classification
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.
Gastrointestinal perforation can be classified by causes into:
Instrumental:
- Instrumentation of the gastrointestinal tract includes upper endoscopy, sigmoidoscopy, colonoscopy, stent placement, endoscopic sclerotherapy, nasogastric intubation, esophageal dilation, and surgery. All of these procedures carry risk of gastrointestinal perforation.[1][2]
- 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.
- Gastrointestinal leakage can also occur postoperatively as a result of anastomotic breakdown.[3]
- Immunosuppressed individuals may be at increased risk for perforation and deep organ space infection following surgery.[4][5]
Systemic:
- Crohn’s disease[6]
- Celiac disease[7]
- Graft-vs-host disease[8]
- Infections:
- Viral: Cytomegalovirus[9]
- Bacteria: Salmonella paratyphi, mycobacterium tuberculosis[10][11][12][13]
- Parasites: Ascaris lumbricoides[14]
- Protozoa: Entameba histolytica
- Drugs: NSAIDs and indomethacin
- Enteric-coated potassium chloride
- Monoclonal antibodies: Bevacizumab
- Meckel’s diverticulum
Inflammatory
- Crohn's disease has a propensity to perforate slowly, leading to formation of entero-enteric or enterocutaneous fistula formation.
- Diseases such as typhoid, tuberculosis, or schistosomiasis can perforate the small intestine.
- The perforations usually occur in the ileum at necrotic Peyer's patches.
Medication
- Aspirin, potassium, disease-modifying antirheumatic drugs, and non-steroidal anti-inflammatory drug use have been associated with perforation.
Neoplasm
Gastrointestinal perforation can be classified by age into:
- Adult-type gastrointestinal perforation
- Neonatal gastrointestinal perforation:
- Necrotising enterocolitis
- Spontaneous
- Iatrogenic
- Umbilical catheterization
- Umbilical cord clamping
- Nasogastric tube
- Obstruction
- Ileal atresia
- Gastric volvulus
- Gastroschisis
- Perforated inguinal hernia
References
- ↑ Raju GS (September 2011). "Gastrointestinal perforations: role of endoscopic closure". Curr. Opin. Gastroenterol. 27 (5): 418–22. doi:10.1097/MOG.0b013e328349e452. PMID 21778877.
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ 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.