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Surgery for perforated small bowel malignancy: a single institution's experience over 4 years
Ker-Kan Tan1, Shieh-Ling Bang, Choon-Kiat Ho
1Department of General Surgery, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore 308433, Singapore. kerkan@gmail.com
Introduction:
Surgery for perforated small bowel malignancy is associated with dismal morbidity and mortality rates. The aim of the paper was to highlight our institution's surgical experience in the management of patients with malignant small bowel perforation.
Methods:
A retrospective review of all patients who underwent operative intervention for malignant small bowel perforation from 2004 to 2007 was performed. The diagnosis was confirmed upon histological evaluation.
Results:
Emergency surgery was performed in seven patients with perforated small bowel malignancy during the study period. All were above 55 years old, with the majority (6/7) having an ASA score of 3 and above. Pneumoperitoneum on chest radiograph was seen in only one patient while computed tomographic scans demonstrating the pathology were performed in the rest. All patients underwent exploratory laparotomy with resection of the diseased segments within 24 h of admission. Jejunum and the ileum were the sites of perforation in six and one patients, respectively. Three patients had synchronous small bowel tumours. Two patients had stoma created due to extensive peritoneal soilage and haemodynamic instability. Lymphoma was the aetiology in four patients. The other pathologies included leiomyosarcoma (n = 1) and metastatic lung tumours (n = 2). The 30-day peri-operative mortality rate was 42.9% (n = 3). One was discharged to a hospice while another two received chemotherapy upon discharge. These three patients passed away within a year from the surgery. The last patient defaulted follow up.
Conclusion:
In our small series, patients who were admitted for perforated small bowel malignancy have a high peri-operative mortality rates. For those who survived the initially operation, the long term outlook is still dismal.
Insights
Surgery for perforated small bowel malignancy carries high mortality. Patients undergoing emergency surgery for this condition face dismal long-term outcomes, underscoring the severity of malignant small bowel perforation.
Area of Science:
- Gastroenterology
- Surgical Oncology
- Abdominal Surgery
Background:
- Perforated small bowel malignancy presents significant surgical challenges.
- High morbidity and mortality rates are associated with emergency surgical intervention.
Purpose of the Study:
- To review the institution's surgical experience in managing malignant small bowel perforation.
- To analyze outcomes for patients undergoing surgery for this condition.
Main Methods:
- Retrospective review of patients undergoing surgery for malignant small bowel perforation (2004-2007).
- Histological confirmation of diagnosis.
- Analysis of peri-operative and long-term outcomes.
Main Results:
- Seven patients (age >55, ASA score ≥3) underwent emergency surgery.
- Common etiologies included lymphoma (4), leiomyosarcoma (1), and metastatic lung tumors (2).
- 30-day peri-operative mortality was 42.9%; long-term survival remained poor.
Conclusions:
- Malignant small bowel perforation is associated with high peri-operative mortality.
- Long-term prognosis for survivors of emergency surgery is dismal.
- Urgent surgical management is critical but outcomes remain poor.
