Traumatic Gastrointestinal Perforation-An Overview of Types and Methods of Management (original) (raw)

The oesophagus is a muscular tube, approximately 25 cm long, mainly occupying the posterior mediastinum and extending from the upper oesophageal sphincter (the cricopharyngeusmuscle) in the neck to the junction with the cardia of the stomach. The musculature of the upper oesophagus, including the upper sphincter, is striated. This is followed by a transitional zone of both striated and smooth muscle with the proportion of the latter progressively increasing so that, in the lower half of the oesophagus, there is only smooth muscle. It is lined through-out with squamous epithelium. The parasympathetic nerve supply is mediated by branches of the vagus nerve that has synaptic connections to the mesenteric (Auerbach's) plexus.Meissner'ssubmucosalplexus is sparse in the oesophagus. The upper sphincter consists of powerful

Perforations of the Esophagus and Stomach: What Should I Do?

Journal of Gastrointestinal Surgery, 2014

Introduction Esophageal and gastroduodenal perforations are relatively uncommon; however, they both can be potentially lifethreatening. Esophageal perforations most commonly occur due to iatrogenic injury, forceful retching (Boerhaave's syndrome), malignancy, foreign body ingestion, or caustic injury. Gastroduodenal perforations are most commonly due to peptic ulcer disease or malignancy. Pain and signs of sepsis are the most common presenting symptoms and signs. Methods Determining the extent of critical illness and addressing hemodynamics and sepsis are the first priorities. Identifying the location and size of the perforation as well as extent of contamination is the next priorities. Although surgical intervention has been the mainstay of treatment, newer approaches have led to a heterogeneity of approaches. Conclusion For esophageal perforation, observation, endoscopic, radiological, and surgical approaches may be appropriate. For gastroduodenal perforation, surgical approach is still the most appropriate, although a concomitant acid-reducing operation is usually not necessary. Despite these advances, mortality for both perforations can still be high. Sound judgment is necessary for optimal results.

Case Report on Two Large Duodenal Perforations and Their Management in Emergency Conditions

International Journal of Integrative Medical Sciences, 2016

Duodenal trauma and its management has always been a hard task and presents as a situational dilemma in surgical emergencies. Very limited work guidelines and standards are available for the management of these complex injuries. Triple tube technique as pure procedure or with its situational modifications is seen as an ideal repair for duodenal perforations. Gastrojejunostomy seemingly is a better option to gastrostomy when large perforations are being repaired for which lumen narrowing is expected.

Insight into the management of non-traumatic perforation of the small intestine

2010

Introduction: Management of non-traumatic perforation of the small intestine has always been a consideration for surgeons because of associated enormous morbidity and mortality. There is a paucity of data on the management of non-traumatic perforation of the small intestine. Methodology: A retrospective study was conducted which involved analysis of 192 patients treated for non-traumatic perforation of small intestine in a tertiary care teaching hospital in North India. The clinical profile and management of the patients were studied. Results: The most common cause of non-traumatic perforation of small intestine was typhoid (46.4%), followed by non-specific inflammation (39.2%), tuberculosis (12.8%) and malignant neoplasm (1.6%). Primary repair was the most frequent procedure (44.0%), followed by ileostomy (25.5%) and resection-anastomosis (19.3%). Superficial wound infection was the most frequent postoperative complication (46.8%), followed by wound dehiscence (31.3%). The wound infection rate was reduced significantly following delayed primary closure of skin incision. Enterocutaneous fistula/leak developed in 11.5% patients. Salvage ileostomy for post-operative intestinal leak resulted in a better survival rate as compared to conservative treatment (85.7% vs. 50.0%). The overall mortality rate was 16.6%. Conclusion: Operative procedures undertaken for the management of non-traumatic perforation of small intestine can be classified into two groups: procedures that leave an intestinal suture line inside the peritoneal cavity and procedures that do not. The no suture line-in procedure seems to be better option in adverse patient conditions.

Traumatic isolated perforation of lower oesophagus

Trauma Case Reports, 2016

One of the rarest cases of non-iatrogenic oesophageal perforation is falling from height. We report a case of a 26 year old man with oesophageal perforation resulting from a fall of 12 meter height. A pneumomediastinum in the absence of a pneumothorax and contrast extravasation from the oesophagus on CT evoked a perforation of the aerodigestive tract. No other injuries were seen. A non-operative management was pursued with good outcomes.

Endoscopic treatment of iatrogenic gastrointestinal perforations: An overview

Digestive and Liver Disease, 2014

In the past, the treatment of iatrogenic gastrointestinal perforations was limited to surgical management or to medical observation. Natural Orifice Transluminal Endoscopic Surgery (NOTES) has paved the way towards the development of reliable endoscopic closure techniques, which can be applicable in accidental perforations of the gastrointestinal tract. When endoscopic treatment is feasible, hemoclips are preferred in smaller perforations, while overthe-scope-clips or a combination of hemoclips, endoloops, and glue are used in larger ones. Endoscopic stitching is rarely utilized, and endoscopic stapling has been practically abandoned. The use of selfexpandable covered stents can be considered in the esophagus and duodenum. Broad spectrum antibiotics are recommended in most cases. Clinical follow-up in a medico-surgical unit is mandatory and surgical intervention should not be delayed more than 24 h if clinical or biological worsening occurs. Imaging with oral contrast medium is advisable before resumption of oral feeding in the case of large perforations.

The successful use of simple tube duodenostomy in large duodenal perforations from varied etiologies

International Journal of Surgery Case Reports, 2013

INTRODUCTION: Tube decompression of the duodenum is an old but underutilized technique known to decrease morbidity and mortality in patients with difficult to manage duodenal injuries. Broad arrays of techniques have been described in the literature and are reviewed, but most are complex procedures not appropriate for the management of an unstable patient. PRESENTATION OF CASE: In this paper we describe the technique of tube duodenostomy and the successful application in three cases of large defects (>3 cm) which two of these cases had failed previous repair attempts. The defects were caused by very different etiologies, including blunt trauma, peptic ulcer disease and erosion from cancer. All were finally managed by application of tube duodenostomy with success. DISCUSSION: Patients with "difficult to manage duodenum" usually present with hemodynamic instability with hostile abdomen. Complex procedures in an unstable patient are associated with adverse outcomes. In patients with significant comorbidities and instability the damage control principle of trauma surgery is gaining popularity. Tube duodenostomy technique described in this paper fits in well with that principle. CONCLUSION: Application of tube duodenostomy instead of a complex procedure in an unstable patient provides an opportunity to stabilize the patient, converting an impending catastrophe to a future scheduled surgery.

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