Incidence Of Intestinal Perforation Research Articles

S0165 The Impact of Cirrhosis on the Outcomes of Hospitalized Patient With Diverticulitis: A Nationwide Analysis

INTRODUCTION: Patients with cirrhosis have increased portal-systemic shunting and intestinal permeability, and therefore are at risk of bacterial translocation and infectious complications following acute diverticulitis. In this study, we evaluate the effect of cirrhosis on the outcomes of hospitalized patients with acute diverticulitis. METHODS: Patient cases with inpatient stays for acute diverticulitis were selected from the 2011 to 2017 National Inpatient Sample and were stratified by the presence of cirrhosis. Patients with coexisting inflammatory bowel disease were excluded from the selection process. The endpoints included mortality, length of stay (LOS), hospitalization costs, and colonic complications. RESULTS: A total of 416573 patients with acute diverticulitis were identified from the database. Of these patients, 3887 (0.93%) had cirrhosis. Compared to the non-cirrhosis cohort, the cirrhosis cohort had no difference in age (63.3 vs 62.8y P = 0.43) but was more likely to be male (54.8 vs 41.7% P < 0.01). The mortality rate was higher in the cirrhosis cohort (4.53 vs 1.32% P < 0.01, OR 3.56 95% CI 3.05–4.15), as were the LOS (7.01 vs 5.40d P < 0.01) and hospitalization costs ($67,048 vs $47,726 P < 0.01). In terms of colonic complications, the cirrhosis cohort had higher incidences of clostridium difficile infection (2.19 vs 0.93% P < 0.01, OR 2.38 95% CI 1.92–2.96), intestinal abscess formation (45.5 vs 43.8% P = 0.04, OR 1.07 95% CI 1.01–1.14), sepsis (16.5 vs 9.19% P < 0.01, OR 1.95 95% CI 1.79–2.12), intestinal fistula (5.15 vs 4.32% P = 0.01, OR 1.20 95% CI 1.04–1.39). However, no difference was found in the incidences of intestinal obstruction (3.83 vs 4.08% P = 0.46, OR 0.94 95% CI 0.79–1.10), volvulus (0.10 vs 0.08% P = 0.84, OR 1.27 95% CI 0.47–3.41), intussusception (0.05 vs 0.04% P = 0.93, OR 1.44 95% CI 0.36–5.79), and fecal impaction (0.36 vs 0.40% P = 0.79, OR 0.90 95% CI 0.53–1.52). The incidence of intestinal perforation was also lower in the cirrhosis cohort (9.31 vs 12.0% P < 0.01, OR 0.75 95% CI 0.67–0.84). In a multivariate model, cirrhosis was found to be associated with increased mortality in patients with acute diverticulitis (P = 0.01, aOR 1.35 95% CI 1.06–1.71). CONCLUSION: Cirrhosis is associated with increased risks of death, infection, and fistulous complications in hospitalized patients with acute diverticulitis. These patients therefore require early risk-assessment and multidisciplinary management of infection and fistulous complications that are detected on imaging or colonoscopy.Figure 1.: Multivariate model: cirrhosis is associated with increased mortality in hospitalized patients with acute diverticulitis.

Prophylactic efficacy of enteral antifungal administration of miconazole for intestinal perforation, especially for necrotizing enterocolitis: a historical cohort study at a single institution.

Despite improvements in neonatal intensive care, the outcomes of extremely-low-birth-weight infants (ELBWIs) with surgical diseases remain to be improved. We started administering enteral miconazole (MCZ) to ELBWIs from 2002 to prevent fungal infection. Since then, the incidence of intestinal perforation has significantly decreased. We investigated this prophylactic effect of MCZ against necrotizing enterocolitis (NEC) and focal intestinal perforation (FIP) and explored a new prophylactic concept against intestinal perforation. We designed a historical cohort study to evaluate the effect of MCZ for intestinal perforation in ELBWIs who underwent treatment in our neonatal intensive-care unit between January 1998 and December 2005. We divided these cases into two groups: the Pre-MCZ group and the Post-MCZ group. We compared the morbidity, clinical outcomes and pathological features of NEC and FIP. The rate of intestinal perforation with NEC was significantly reduced after the introduction of MCZ (p = 0.007, odds ratio; 3.782, 95% confidence interval; 1.368-12.08). The pathological findings of NEC specimens showed that the accumulation of inflammatory cells was significantly reduced in the Post-MCZ group when compared with the Pre-MCZ group (p < 0.05). The efficacy of the enteral administration of MCZ on intestinal perforation with NEC highlights a new prophylactic concept in the clinical management of ELBWIs.

Comparison of clinical features between very earl-onset inflammatory bowel diseases and late-onset inflammatory bowel diseases

Objective To summarize the clinical data of the children with inflammatory bowel diseases(IBD), including Crohn′s disease (CD) and ulcerative colitis (UC), and to analyze and compare the clinical features of very early-onset IBD (VEO-IBD) and late-onset IBD (LO-IBD). Methods A retrospective analysis of the clinical data of 184 cases of IBD hospitalized children diagnosed at Beijing Children′s Hospital, Capital Medical University from January 2000 to December 2014.According to their ages of onset, the patients were divided into VEO-IBD group (<6 years old) and LO-IBD group (6-16 years old); the patients with CD were divided into VEO-CD group (<6 years old) and LO-CD group (6-16 years old); UC were divided into VEO-UC group (<6 years old) and LO-UC group (6-16 years old). The clinical features among each group were analyzed and compared. Results A total of 184 IBD patients were included in the study, 77 cases(41.8%) were VEO-IBD and 107 cases(58.2%) were LO-IBD.Comparison between VEO-CD group and LO-CD group indicated that abdominal pain was more common in LO-CD group(P<0.05), while diarrhea and hematochezia were more common in VEO-CD group(all P<0.05). In addition, comparison between VEO-UC group and LO-UC group indicated that abdominal pain was more common in LO-UC group(P<0.001), while diarrhea, fever, and oral ulcers were more common in VEO-UC group (all P<0.05). Both VEO-CD and LO-CD group were mainly ileocolonic[15/27 cases (55.6%), 20/47 cases (42.6%)], non-narrow, non-penetrating [20/27 cases (74.1%), 30/47 cases (63.8%)] and moderate-to-severe activity[23/27 cases(85.2%), 37/47 cases (78.7%)]. The incidence of perianal lesions in the VEO-CD group was as high as 51.9% (14/27 cases), which was significantly higher than that in the LO-CD group (9/47 cases, 19.1%) (P<0.05). Left-sided UC and severe UC were more common in VEO-UC group(all P<0.05), while pancolitis and mild UC were more common in LO-UC group (all P<0.05). The incidence of intestinal perforation in the VEO-UC group was significantly higher than that in the LO-UC group (P<0.05). The incidence of surgical rate, intestinal obstruction, and intestinal perforation in the LO-CD group were significantly higher than those in the LO-UC group (all P<0.05). Conclusions Compared between VEO-IBD and LO-IBD, VEO-IBD patients are more severe, with perianal lesions more common, and the incidence of intestinal perforation is higher. Key words: Inflammatory bowel disease, very early-onset; Crohn′s disease; Colitis, ulcerative; Child

Treatment and outcome of intestinal perforation after liver transplant surgery in adults: a single-center experience.

ObjectiveIntestinal perforation is a rare complication after liver transplantation. This study was designed to calculate the incidence and investigate the outcomes of intestinal perforation in adult liver transplant patients.Materials and methodsThe clinical records of liver transplant recipients between January 2014 and June 2016 were obtained. The incidence of intestinal perforation was calculated, and high risk factors were analyzed.ResultsThe mean operative time was 8.5 h (range: 6–11 h). The mean portal vein occlusion time was 66.5 min (range: 58–72 min), and the mean cold ischemia time was 7.9 h (range: 6.5–9.5 h). Four (2.7%) patients developed intestinal perforation from 9 to 14 days postliver transplant. All perforations were single and repaired by interrupted silk sutures. Two patients uneventfully recovered, but intestinal perforation recurred in two other patients. Simple repair was undertaken in one patient, and terminal ileum resection and ileostomy were performed in the other patient. There were no perioperative deaths.ConclusionThe incidence of intestinal perforation after liver transplantation is low. Prompt diagnosis and treatment should be carried out to reduce comorbidities and mortality.

Prophylactic efficacy of enteral miconazole administration for neonatal intestinal perforation and its potential mechanism.

Intestinal perforation (IP) is a fatal complication in extremely low birth weight infants (ELBWI). We started administrating enteral miconazole (MCZ) to ELBWI in 2002. Since then, the incidence of IP has significantly decreased. The aim of this study was to elucidate the prophylactic effect of MCZ for the treatment of neonatal IP, and to establish a new prophylactic concept for this disease. In in vivo experiments, the effects of MCZ were examined histopathologically using a mouse model of intestinal ischemia. In in vitro experiments, the cytoprotective effect of MCZ against hypoxia was evaluated using Caco-2 intestinal cells, and its anti-inflammatory potential using a co-culture model of Caco-2 and HL60 cells. MCZ showed a tissue protective effect against intestinal ischemia. MCZ reduced high mobility group-box 1 (HMGB1) release in Caco-2 cells under hypoxic stress and attenuated the potential to activate co-cultured HL60 leukocytes with Caco-2 cells by suppressing interleukin-8 (IL-8). MCZ may have preventive roles in the clinical management of IP in ELBWI by the suppression of IL-8 and HMGB-1.

Trends in the incidence of intestinal perforation in US dialysis patients (1992-2005)

Little is known about the incidence of intestinal perforation in patients undergoing dialysis. Concerns exist that sevelamer hydrochloride may increase the risk of intestinal perforation. We examined long-term trends for the incidence of intestinal perforation among US dialysis patients. We studied all dialysis patients (1992-2005) who had Medicare as primary payer. We used ICD-9 diagnosis code 569.83 to ascertain events of intestinal perforation. We studied (a) all perforations and (b) perforations that did not appear to be associated with specific causative conditions (specific diseases or iatrogenic procedures within 7 days of perforation). We used Poisson regression to model the annual number of intestinal perforations and tested for any changes in levels and temporal trends of incidence rates before versus after January 1, 1999. Overall, 1,060,132 patients contributed 2.7 million patient-years. We observed 12,355 events of intestinal perforation and 7,814 spontaneous perforations. The corresponding incidence rates were 4.6 (total) and 2.9 (spontaneous perforation) episodes per 1,000 person-years, respectively. For both outcome definitions, 30-day mortality was 42%. Unadjusted and adjusted incidence rates were not materially different over time. Formal tests for any changes in the level or slope of incidence comparing time periods before and after January 1, 1999, indicated no evidence for any changes in the incidence of intestinal perforation over time. In US dialysis patients, incidence of intestinal perforation was low, but associated with high short-term mortality. We did not detect any significant changes in the incidence of intestinal perforation before versus after approval of sevelamer hydrochloride in late 1998.

Meconium‐related ileus in extremely low‐birthweight neonates: Etiological considerations from histology and radiology

A nationwide survey on neonatal surgery conducted by the Japanese Society of Pediatric Surgeons has demonstrated that the mortality of neonatal intestinal perforation has risen over the past 15 years. The incidence of intestinal perforation in extremely low-birthweight (ELBW) neonates has been increasing as more ELBW neonates survive and as the live-birth rate of ELBW has increased. In contrast to necrotizing enterocolitis (NEC) and focal intestinal perforation (FIP), the pathogenesis of meconium-related ileus, defined as functional bowel obstruction characterized by delayed meconium excretion and microcolon, remains unclarified. The histology of 13 ELBW neonates with intestinal perforation secondary to meconium-related ileus was reviewed, and the radiology of 33 cases of meconium-related ileus diagnosed on contrast enema was reviewed. Specimens obtained from 16 ELBW neonates without gastrointestinal disease served as age-matched controls for histological assessment. The size of the ganglion cell nucleus in meconium-related ileus and in control subjects was 47.3 ± 22.0 µm(2) and 37.8 ± 11.6 µm(2), respectively, which was not significantly different. In all cases of meconium-related ileus, contrast enema demonstrated a microcolon or small-sized colon, with a gradual caliber change in the ileum and filling defects due to meconium in the ileum or colon, showing not-identical locations of caliber changes and filling defects. Morphological immaturity of ganglia was not suggested to be the pathogenesis of meconium-related ileus. Impaction of inspissated meconium is not the cause of obstruction, but the result of excessive water absorption in the hypoperistaltic bowel before birth, although the underlying mechanism responsible for the fetal hypoperistalsis remains unclear.

Jejunal perforation and peroral extrusion of a peritoneal shunt catheter

The incidence of intestinal perforation following a ventriculo-peritoneal shunt (VPS) insertion ranges between 0.1 and 0.7% of all abdominal complications of this procedure.[1] Perforation of the c...

Effect of prophylactic indomethacin in extremely low birth weight infants

Purpose:The purpose of this study was to investigate the effect of prophylactic indomethacin on reduction of patent ductus arteriosus(PDA) and intraventricular hemorrhage(IVH) in extremely low birth weight infants(ELBWI). Methods:Retrospective review of 84 ELBWI who were admitted to our neonatal intensive care unit from June 2004 to April 2006 was performed. Patients were divided into prophylactic group(n=28) and control group(n=56), where prophylactic indomethacin were given within 6 hours after birth. Clinical outcomes were compared between these groups. Results:There were no significant differences in gestational age, birth weight, incidence of hemodynamically significant PDA and severe IVH, and mortality between prophylactic group and control group. However, there were more frequent indications for therapeutic indomethacin, higher incidence of intestinal perforation, and longer time to achieve full enteral feeding in prophylactic group than control group. The incidence of other adverse events attributed to indomethacin prophylaxis did not differ between two groups. Conclusions:Prophylactic indomethacin may not prevent hemodynamically significant PDA and severe IVH in ELBWI. On the contrary, it may be associated with increased risk of adverse events. Further efforts should be investigated to decrease PDA and severe IVH in ELBW

Incidental appendicectomy with laparotomy for trauma

Incidental appendicectomy was performed in 83 of 206 patients undergoing laparotomy for abdominal trauma. No organs were injured in 42 per cent of the appendicectomy patients and in 17 per cent of the non-appendicetomy patients, thus making comparison between the groups unreliable. While the incidence of intestinal perforation was 21 per cent in the appendicectomy patients, the rate of wound infection was only 7 per cent. One complication (pelvic abscess) was possibly attributable to incidental appendicetomy. Since males below the age of 50 face a significant risk of future appendicitis and represent the majority of patients with abdominal trauma, it may be advisable to perform incidental appendicectomy with laparotomy for trauma in such patients. Specific indications for incidental appendicectomy during laparotomy for trauma are suggested.

The Ultra Low Birth Weight (LBW) Infants May Be Particularly Vulnerable to Intestinal Perforation (IP) 1103

Reports indicate that for preterm infants intestinal perforation (IP) is an emerging disease (Acta Ped 1996). Others quote high mortality (48%) with NEC and perforation (Surgery 1996) but no specific cause is delineated. Recently, we experienced an increased incidence of IP in ELBW infants.