Perforated Viscous

Description

• Surgical emergency with mortality of 20–50%
• Perforation/break in the containing walls of an organ with contents spilling into peritoneal cavity
• Inflammation/infection
• Ulceration
• Shearing/crushing or bursting forces in trauma
• Obstruction
• Chemical and/or bacterial peritonitis occur as result of disruption of gastric or intestinal lining into peritoneal cavity

Etiology

• Esophageal
• Peptic ulcer disease:
  • Majority of cases caused by NSAIDs and Helicobacter pylori, in addition to steroids and aspirin
• Small bowel:
  • Ischemia, foreign body, neoplasms, inflammatory bowel disease
• Large bowel:
  • Diverticular disease, foreign body, neoplasms, inflammatory bowel disease, volvulus
• Intestinal ischemia
• Appendicitis
• Penetrating or blunt trauma to lower chest/abdomen
• Iatrogenic:
  • Endoscopy, colonoscopy
• Radiation enteritis and proctitis

• Trauma is the more common cause of rupture:
  • Neonates with difficult birth/child abuse/motor vehicle accidents, and falls
• Jejunum is the most common site of rupture