Perforated Viscous
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Basics
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
Pediatric Considerations
- 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
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Basics
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
Pediatric Considerations
- 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
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