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Unrecognized viscus perforation in the elderly.

J D Fulton1, S E Peebles, G D Smith

  • 1Department of Geriatric Medicine, Stobhill General Hospital, Glasgow.

Age and Ageing
|November 1, 1989
PubMed
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Missed diagnoses of intra-abdominal perforation are common, especially in elderly obese women. Factors like obesity, communication issues, and certain medications contribute to delayed recognition of this curable condition.

Area of Science:

  • Medical research
  • Surgical outcomes
  • Diagnostic challenges

Background:

  • Intra-abdominal perforation is a critical surgical emergency.
  • Delayed diagnosis significantly impacts patient outcomes.
  • Identifying factors contributing to missed diagnoses is crucial for improving patient care.

Purpose of the Study:

  • To analyze factors contributing to missed diagnoses of intra-abdominal perforation.
  • To identify high-risk patient groups for this condition.
  • To highlight key clinical indicators for earlier detection.

Main Methods:

  • Retrospective analysis of 34 consecutive patients with unrecognized intra-abdominal perforation.
  • Review of post-mortem records.
  • Identification of common contributing factors to diagnostic delays.

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Main Results:

  • Obesity (50%), previous abdominal surgery (38%), and communication difficulties (33%) were common factors in missed diagnoses.
  • Medications (NSAIDs 44%, analgesics 26%, steroids 21%) and cardiopulmonary presentations (79%) obscured symptoms.
  • Unexplained tachycardia (38%), hypotension (59%), and pyrexia (29%) were associated with perforation.

Conclusions:

  • Elderly obese women are identified as a particularly at-risk group.
  • Clinical suspicion is essential, especially with atypical presentations.
  • Prompt diagnosis and treatment of gastro-intestinal perforation are vital for curability.