Study of the prognostic factor of the colon perforation case with the pan‐peritonitis that needed emergency surgery: a single‐center observational study

Abstract

Aim We divided patients treated with emergency surgery for pan‐peritonitis caused by colon perforation into the survival group and the death group based on outcome at postoperative day 30 and examined the prognostic factors for colon perforation. Methods The prognostic factors for colon perforation in 76 consecutive patients who underwent emergency surgery at Kansai Medical University Hospital (Hirakata, Japan) from April 2011 to March 2017 were investigated based on outcome at postoperative day 30. Results The average age of the 76 patients (41 men/35 women) was 73 years, and the causative disease of colon perforation was malignant/benign in 18/58 cases, with ileocecal perforation site in 8 cases, ascending colon in 6, transverse colon in 2, descending colon in 4, sigmoid colon in 49, and rectum in 7. All patients received laparotomy with irrigation drainage, and 9 patients (11.8%) were dead at 30 days. Upon comparing the 67 survivors with the 9 dead patients, we recognized a significant difference on preoperative spread of ascites on computed tomography (CT) (P = 0.002) in univariate analysis and on acute disseminated intravascular coagulation (DIC) score (odds ratio 2.289; 95% confidence interval, 1.188–4.410; P = 0.013) in multivariate analysis. Conclusion In our hospital, the preoperative acute DIC score was found to be a prognostic factor for colon perforation accompanied by pan‐peritonitis. Appropriate evaluation of the spread of ascites on the preoperative CT might also help predict patient prognosis.

Analysis of risk factors for perioperative mortality in adults with small bowel perforation:a case controlled study

“…The presence of large amounts of Gram-negative bacteria in the colon was thought of as a reason for the higher perforation-related mortality rate as compared with the small bowel. However, the perioperative mortality of colonic perforation reported in the literature [1,2] is not higher than that in this study, probably because the etiologies of perforation in the colon and small intestine are different. It was reported that most colonic perforation cases were caused by benign diseases, and malignant tumors only accounted for about 20% [1,2].…”

“…However, the perioperative mortality of colonic perforation reported in the literature [1,2] is not higher than that in this study, probably because the etiologies of perforation in the colon and small intestine are different. It was reported that most colonic perforation cases were caused by benign diseases, and malignant tumors only accounted for about 20% [1,2]. In the present study, 40% (34/85) were malignant cases and malignant tumor in deaths was account for 81.8% (9/11).…”

“…Horiuchi et al [12] found that APACHE II score was closely related to the prognosis, and the mortality rate would significantly increase if APACHE II score was ≥ 20. However, Nakamura et al [2] failed to find a significant correlation between APACHE II score and prognosis in a study of 76 patients with colon perforation. In this study, the mean APACHE II score of patients in the non-survival group was significantly higher than that of the survival group (24.5 ± 11.5 vs. 14.4 ± 8.41, P = 0.0032) in the patients who entered the ICU after surgery.…”

“…There have been many reports about colonic perforation. The most common causes for colonic perforation include diverticulum, malignant tumors and iatrogenic injuries, causing a perioperative mortality rate of 11-30% [1][2][3][4][5]. Given the different spectrum of diseases between the small and large bowels, the etiologies of perforation and perioperative mortalities are not all the same.…”

Combination of dirty mass volume and APACHE II score predicts mortality in patients with colorectal perforation

“…Scoring systems provide objective and systematic assessment of the severity of colorectal perforation, and various reports have described the utility of scoring systems for predicting the mortality risk of colorectal perforation. Nakamura et al reported acute DIC score as the strongest predictor of mortality by multivariate analysis [ 11 ] and reported SOFA and POSSUM scores as significant markers in univariate analysis, but not APACHE II ( p = 0.053). SOFA and POSSUM scores have been reported as useful prognostic markers for colorectal perforation in other studies [ 12 , 13 ].…”