Gastrointestinal perforation risk factors

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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

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Other causes
  • Violent retching can lead to spontaneous esophageal perforation, known as Boerhaave syndrome due to increased intraesophageal pressure in the lower esophagus. [51]
Gastric causes
  • Peptic ulcer disease is the most common cause of stomach and duodenal perforation.
  • Marginal ulcers may complicate procedures involving a gastrojejunostomy.
  • Perforated gastric ulcer is associated with a higher mortality, possibly related to delays in diagnosis. [121].
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Neonatal intestinal perforation risk factors

Risk factors for necrotizing enterocolitis (NEC):

  • Ninety percent of NEC cases occur in preterm infants due to immaturity of the gastrointestinal tract. [7,8][39,40].
  • Preterm infants have lower concentrations or more immature function of contributing mucosal defense factors than do term infants and adults [4].
  • Preterm infants have high levels of cytokines such as tumor necrosis factor, IL-1, IL-6, IL-8, IL-10, IL-12, and IL-18 that increase vascular permeability and attract inflammatory cells. [22,74-77].
  • Human milk is more protective against NEC in preterm infants than formulas. The mucus coat of the intestine is less affected by human milk than formulas.
  • Growth factors within human milk repair disturbed layers in intestine.
  • Bacterial colonization is believed to play a pivotal role in the development of NEC.
  • Rapid colonization of the intestinal tract by commensal bacteria from the maternal rectovaginal flora normally occurs. [8,21-24].
  • Ischemic insult to the GI tract has been proposed as a major contributor to NEC. [30,49,50]. Inflammatory mediators induced by ischemia, infectious agents, or mucosal irritants may cause mucosal injury. [22,73].
  • Events that have been implicated in the development of NEC include:
  • perinatal asphyxia [51]
  • Recurrent apnea
  • Respiratory distress syndrome
  • Hypotension
  • Congenital heart disease [52,53]
  • Patent ductus arteriosus
  • Umbilical arterial catheterization
  • Anemia
  • Polycythemia [54,55][59]
  • Medications such as theophylline or phenobarbital might irritate the intestinal mucosa. [70].

Risk factors for spontaneous intestinal perforation of the newborn:

References