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[Surgery for Lower Intestinal Perforation Due to Peritoneal Dissemination]
Megumi Sano1, Kazuhiko Yoshimatsu, Shinichi Asaka
1Dept. of Surgery, Tokyo Women's Medical University Medical Center East.
Gan to Kagaku Ryoho. Cancer & Chemotherapy
|February 28, 2018
Summary
Surgery for lower intestinal perforation with peritoneal dissemination is challenging. While outcomes are often poor, some patients may achieve oral intake or hospital discharge after surgical intervention.
Area of Science:
- Gastroenterology
- Surgical Oncology
- Critical Care Medicine
Background:
- Investigating surgical outcomes for lower intestinal perforation in patients with peritoneal dissemination.
- Analyzing emergency operations for a rare but critical surgical condition.
Observation:
- Four patients (2 male, 2 female, median age 65.5) with peritoneal dissemination underwent emergency surgery for lower intestinal perforation.
- Perforations involved the small intestine (3 cases) and ascending colon (1 case); APACHE II scores averaged 14.5.
- Surgical procedures included resection and stoma creation; bacterial peritonitis control was difficult in 50% of cases.
Findings:
- Two patients died within 16 days due to uncontrolled bacterial peritonitis.
- One patient was discharged, continuing best supportive care (BSC), and survived 4 months post-surgery.
- Despite poor long-term prognosis, surgical intervention allowed oral intake resumption or discharge in some cases.
Implications:
- Surgical treatment for lower intestinal perforation with peritoneal dissemination, though high-risk, may offer survival benefits or improved quality of life.
- Further research is needed to optimize surgical strategies and perioperative management for this patient group.
- This study highlights the complex management and variable outcomes associated with advanced peritoneal dissemination and intestinal perforation.
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