Rodríguez-Hermosa J I, Codina-Cazador A, Sirvent J M, Martín A, Gironès J, Garsot E
Department of Colorectal and General Surgery, Hospital Universitari de Girona Dr Josep Trueta, Girona, Spain.
Colorectal Dis. 2008 Sep;10(7):701-7. doi: 10.1111/j.1463-1318.2007.01401.x. Epub 2007 Nov 12.
Intestinal perforation due to foreign body (FB) ingestion is rare (1%). We describe our experience in treating these lesions surgically.
From 1995 to 2006, data were collected prospectively in 33 patients (18 women and 15 men; mean age 64 years) operated on for intestinal perforation due to an ingested FB. The type of object, preoperative diagnosis, perforation site, treatment, morbidity and mortality were reviewed.
Foreign body ingestion was predominantly involuntary (88%). The mean time from ingestion to perforation was 10.4 days. The most frequently ingested objects were dietary FB (n = 21) and toothpicks (n = 6). The most frequent predisposing factors were dentures or an orthodontic appliance (73%). The most common preoperative diagnoses were acute abdomen of uncertain origin (n = 7), acute appendicitis (n = 7) and acute diverticulitis (n = 5). Pneumoperitoneum was observed in 10 cases. The diagnosis was reached during laparotomy in 30 (91%) cases. The most frequent perforation site was the colorectal region (n = 18, 54.5%), followed by the terminal ileum (n = 7, 21.2%); intraperitoneal perforation was the most common (n = 30, 91%). All cases had abdominal contamination and 22 (66.7%) had diffuse peritonitis. Treatment was always by surgery and antibiotics. Thirteen patients required a colostomy. Morbidity was 57.6% (n = 19) and mortality 6.1% (n = 2).
Intestinal perforation by a foreign body is rare and normally affects the sigmoid colon, rectum or distal ileum. Dentures are a common risk factor. Patients are rarely aware of foreign body ingestion. Dietary FB and toothpicks are the most commonly ingested objects. Treatment consists of surgery and antibiotics. Appendicitis and acute diverticulitis should be considered in the differential diagnosis.
因吞食异物（FB）导致的肠穿孔较为罕见（1%）。我们描述了手术治疗这些损伤的经验。
1995年至2006年，前瞻性收集了33例因吞食FB导致肠穿孔而接受手术的患者（18例女性和15例男性；平均年龄64岁）的数据。回顾了异物类型、术前诊断、穿孔部位、治疗、发病率和死亡率。
异物吞食主要为非自愿性（88%）。从吞食到穿孔的平均时间为10.4天。最常吞食的异物是食物性FB（n = 21）和牙签（n = 6）。最常见的诱发因素是假牙或正畸矫治器（73%）。最常见的术前诊断是原因不明的急腹症（n = 7）、急性阑尾炎（n = 7）和急性憩室炎（n = 5）。10例观察到气腹。30例（91%）在剖腹手术时确诊。最常见的穿孔部位是结直肠区域（n = 18，54.5%），其次是回肠末端（n = 7，21.2%）；腹腔内穿孔最为常见（n = 30，91%）。所有病例均有腹腔污染，22例（66.7%）有弥漫性腹膜炎。治疗始终采用手术和抗生素。13例患者需要行结肠造口术。发病率为57.6%（n = 19），死亡率为6.1%（n = 2）。
异物导致的肠穿孔罕见，通常累及乙状结肠、直肠或回肠末端。假牙是常见的危险因素。患者很少意识到吞食了异物。食物性FB和牙签是最常吞食的异物。治疗包括手术和抗生素。鉴别诊断时应考虑阑尾炎和急性憩室炎。
