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Large bowel perforation: morbidity and mortality.
K Bielecki1, P Kamiński, M Klukowski
1Department of General and Gastroenterological Surgery, Postgraduate Medical Education Centre, Warsaw, Poland.
Techniques in Coloproctology
|January 15, 2003
Summary
Large bowel perforation is a severe complication. Aggressive surgical management, particularly primary resection with anastomosis, is recommended, especially when the Mannheim Peritonitis Index (MPI) is low, to improve patient survival.
Area of Science:
- Gastroenterology
- Surgical Oncology
- Emergency Medicine
Background:
- Large bowel perforations are rare but serious, often linked to colorectal cancer or diverticulitis.
- Surgical treatment strategies for these perforations remain a subject of debate.
Purpose of the Study:
- To evaluate mortality predictors and the safety of primary resection and anastomosis in patients with large bowel perforation.
- To assess the impact of surgical techniques and peritonitis severity on outcomes.
Main Methods:
- Retrospective analysis of 59 emergency surgical cases of large bowel perforation.
- Patients were categorized by surgical procedure: resection with anastomosis, resection without anastomosis, or non-resective procedures.
- Peritonitis severity was graded using Hinchey's classification and the Mannheim Peritonitis Index (MPI).
Main Results:
- Overall mortality was 16.9%.
- Lower MPI scores correlated with better survival and favored resection with anastomosis over resection alone.
- Mortality rates were 11.1% for resection with anastomosis versus 22.2% for resection without anastomosis. Patients with MPI < 25 had no mortality.
Conclusions:
- A radical, aggressive surgical approach is generally advised for large bowel perforations.
- Outcomes are significantly influenced by the extent of intraperitoneal infection and postoperative complications, which are higher in non-malignant perforations.