Classification und Treatment Algorithm of Small Bowel Perforations Based on a Ten-Year Retrospective Analysis

Abstract

Background: Small bowel perforations are a rare diagnosis compared with esophageal, gastric, and colonic perforations. However, small bowel perforations can be fatal if left untreated. A classification of small bowel perforations or treatment recommendations do not exist to date. Methods: A retrospective, monocentric, code-related data analysis of patients with small bowel perforations was performed for the period of 2010 to 2019. Results: Over a 10-year period, 267 cases of small bowel perforation in 257 patients (50.2% male and 49.8% female; mean age of 60.28 years) were documented. Perforation’s localization was 5% duodenal, 38% jejunal, 39% ileal, and 18% undocumented. Eight etiologies were differentiated: iatrogenic (41.9%), ischemic (20.6%), malignant (18.9%), inflammatory (8.2%), diverticula-associated (4.5%), traumatic (4.5%), foreign-body-associated (1.9%), and cryptical (1.5%) perforations. Operative treatment combined with antibiotics was the most commonly used therapeutic approach (94.3%). The mortality rate was 14.23%, with highest rate for patients with ischemic perforations. Discussion: An algorithm for diagnostic and therapeutic steps was established. Furthermore, it was found that small bowel perforations are rare events with poor outcomes. Time to diagnosis and grade of underlying disease are the most essential parameters to predict perforation-associated complications.

Prevalence, Pattern, Mortality, and Morbidity of Traumatic Small Bowel Perforation at King Abdulaziz Medical City: A Retrospective Cohort Study

“…Regarding gender, our results (Table 1) show that there is a higher prevalence of traumatic bowel perforation in males (87.5%), which is comparable to the results of a study by Onken et al (2022), which indicated that 50.2% of participants with small bowel perforation were males while 49.8% of participants were females [7].…”

“…Regarding gender, our results (Table 1 ) show that there is a higher prevalence of traumatic bowel perforation in males (87.5%), which is comparable to the results of a study by Onken et al (2022), which indicated that 50.2% of participants with small bowel perforation were males while 49.8% of participants were females [ 7 ]. Our results are also comparable to the findings of a study by Mukhopadhyay et al (2009), which showed that the male-to-female ratio for traumatic bowel injury from blunt abdominal trauma was 8.4: 1 [ 16 ].…”

“…Although small bowel perforation is rare, it is a clinically complex medical condition with high mortality and should be diagnosed and managed early for a better prognosis [7,8]. SBP is usually managed by early stabilization, antibiotic therapy, and surgical source control depending on the case and the presence of strong indicators for prompt operative intervention [9][10][11].…”

Endoscopic management of duodenal perforation caused by foreign bodies in adults: A retrospective study

“…Common CT findings of duodenal FB perforation include localized mesenteric fatty infiltration, focal thickening of the bowel wall and pelvic effusion 24 . Free pneumoperitoneum is rare, as the FB is gradually impacted and the perforation is locally covered with fibrin or omentum 24–26 . In addition, endoscopy can be used as a diagnostic tool, as well as for treatment.…”

“… 24 Free pneumoperitoneum is rare, as the FB is gradually impacted and the perforation is locally covered with fibrin or omentum. 24 , 25 , 26 In addition, endoscopy can be used as a diagnostic tool, as well as for treatment.…”