Perforated viscus in patients with liver cirrhosis: How far is it?

Abstract

Background: Gastrointestinal tract perforations can occur for various causes that require an early recognition and, often, a surgical treatment. The goal of this study is to evaluate the management and outcome of perforated viscus in patients with liver cirrhosis. Methods: From April 2013 to April 2015, 69 cirrhotic patients had been presented with perforated viscus at National Liver Institute, Menoufia University. The different varieties of management plans and their impact on prognosis were studied as well as the impact of liver condition on the outcome. Results: In 30 (43.5%) patients the causes of perforation were pathological and the most frequent cause was perforated duodenal ulcer in 10 patients (33%). Iatrogenic perforation represented 56.5% (39 cases), the most frequent of them were ERCP induced perforation, other causes included: colonoscopy induced, percutaneous radiological intervention (Hepatocellular carcinoma ablation or drainage of intraabdominal collections), and diathermal heat injury of GIT wall during abdominal operation. Due to delayed presentation, 8 patients (11.6%) died before any intervention. Conservative management was successful in 17 patients (24.6%) with iatrogenic causes, while the other 44 patients (63.8%) were surgically explored according to the etiology. The Overall hospital mortality was 40.3% (27 cases). Conclusion: Liver cirrhosis carries a negative impact on the prognosis in the patients with perforated viscus. Delayed presentation of perforated viscus carries dreadful outcome. Conservative management is a successful option especially in iatrogenic perforation. Early diagnosis and management of perforated viscus is mandatory to improve the outcome in patients with liver cirrhosis.