Treatment Of Gastrointestinal Perforation Research Articles

Indigenously modified endoluminal vacuum-assisted closure therapy for post-operative gastrointestinal leaks: Successful case series

Treatment of gastrointestinal perforations and postoperative anastomotic leaks remains a challenge. Endoluminal Vacuum-assisted closure (E-Vac) therapy has positively contributed, in recent years

Problems of diagnostics and treatment of gastrointestinal perforations in patients with acute intestinal infections

The results of treatment of 97 patients with perforations of the hollow organs of the gastrointestinal tract were analyzed, 31 acute intestinal infections of which were verified. Clinical features of perforation of hollow organs on the background of acute intestinal infection have been revealed. A comparative analysis of clinical and instrumental methods for diagnosing perforations in patients with intestinal infections and without them was carried out. The most sensitive in identifying perforations of hollow organs in patients with acute intestinal infections instrumental methods of investigation were diagnostic laparoscopy (100%) and radiography of abdominal organs (80%). It was established that the combination of the two diseases contributes to the growth of diagnostic errors, increase in the number of common forms of peritonitis and development of the syndrome of mutual aggravation. Analysis of surgical interventions showed that in patients with confirmed diagnosis of acute intestinal infection the primary surgical interventions in most patients resulted in the formation of laparostoma with programmed relaparotomy, in connection with the presence of contraindications for the formation of a primary interintestinal anastomosis. Postoperative complications in the study groups developed in 61,3; 41.7 and 23,8% of cases, respectively. In patients with confirmed diagnosis of acute intestinal infection, lethality was 32,3%, in patients with atypical flow of perforations of hollow organs, simulating the symptoms of acute intestinal infection - 16,7 and 14,3% - in patients with perforations of hollow organs without concomitant acute intestinal infection. The results of the research testify to the relevance of the problem under study and the need to optimize therapeutic-diagnostic algorithm for this category of patients.

Early diagnosis and treatment of gastrointestinal perforation in neonatology

目的 探讨新生儿胃肠穿孔的诊断和治疗方法.方法39例胃肠穿孔新生儿经X线、B超及腹腔穿刺等明确诊断,胃肠穿孔一经确诊后均采取手术治疗.结果治愈17例,死亡22例,治愈率43.59%.死亡病例与早产低体重儿,延期诊断,误诊,合并感染、休克、多脏器损害等因素有关.结论早期诊断、重视术前处理、合理选择术式及术后常规应用全静脉营养支持是提高疗效的关键。

Bowel Perforation in Steroid-Treated Patients

Gastrointestinal perforation in patients receiving glucocorticosteroid (GCS) therapy has been reported to have mortality rates as high as 100%. From 79 patients seen during a nine-year period, three groups were formed according to GCS dosage: group 1 (steroid perioperative coverage), group 2 (low-dose steroids, prednisone < 20 mg daily), and group 3 (high-dose steroids, prednisone greater than or equal to 20 mg daily). Of 11 clinical presentation factors, only abdominal tenderness was consistently present in group 3. The mean delay from onset of symptoms to treatment for group 3 was 8.3 days and was in marked contrast to that for group 1 or 2, 1.7 and 2.2 days, respectively (p < 0.005). Mortality increased from 11.8% in group 1 to 13.3% in group 2 to 85% in group 3. High-dose GCS therapy decreased the clinical expression of peritonitis to the point that recognition and, therefore, treatment of gastrointestinal perforation were markedly delayed. In a patient receiving high-dose GCS, a high degree of clinical suspicion must accompany any new abdominal discomfort, and aggressive diagnostic efforts should be made to establish the cause. If abdominal pain persists, surgical exploration should be considered.