Perforated Viscous

Perforated Viscous is a topic covered in the 5-Minute Emergency Consult.

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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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