Causes and Incidence of Each Gastrointestinal Tract Perforation from 484 Cases

Lee,  Chang Hyun

J Korean Soc Emerg Med > Volume 10(4); 1999 > Article

Original Article

Journal of The Korean Society of Emergency Medicine 1999;10(4): 615-627.

Causes and Incidence of Each Gastrointestinal Tract Perforation from 484 Cases

ABSTRACT

BACKGROUND: The diagnosis of intraabdominal solid organ injuries is easy for accuracy of the imaging studies, but that of hollow viscus perforations is sometimes relatively difficult. And some of gastrointestinal perforations can be missed and their diagnosis may be delayed. This can result in high morbidity and mortality. So, I studied the incidence and causes of each gastrointestinal tract perforation. METHOD: Four hundred eighty four patients were reviewed, who visited the Emergency Center of Seoul Red Cross Hospital for their gastrointestinal perforations from January, 1987 to December, 1998. Medical records were reviewed in a retrospective manner. The incidence and causes of each hollow viscus perforation, the preferability of each perforation from the pattern of trauma, age and sex distribution in each perforation and associated injuries with trauma were analyzed.
RESULTS:
The most common perforations were in duodenum(254cases, 52.4%) due to mainly peptic ulcer. The incidence was in order of small bowel(32.6%), stomach(7.4%), colorectum(6.6%) and esophagus(0.8%) after that. Trauma induced perforations were 164 cases(33.9%) and the ratio between blunt and penetrating trauma was 3.9 : 1. Small bowel was most vulnerable site of perforation from both trauma. Duodenum and esophagus were relatively stable from trauma. There were no cases from blunt trauma in stomach and esophagus. The male to female ratio was 5.1 : 1.
CONCLUSION:
Each hollow viscus has each preferred cause of perforation. It's diagnosis was not easy everytime, sometimes it was really difficult. But pattern of causes in perforations will be helpful to decision making process. In difficult cases, suspicion is very important. And in suspicious perforation of hollow viscus, diagnosis and the decision to operate will be made by frequent physical examination and proper investigating tests.