Akyildiz Hizir Yakup, Akcan Alper Celal, Sözüer Erdoğan, Küçük Can, Yilmaz Namik, Artiş Tarik
Department of General Surgery, Erciyes University, Faculty of Medicine, Kayseri, Turkey.
Ulus Travma Acil Cerrahi Derg. 2009 Nov;15(6):579-83.
Intestinal perforation is one of the major causes of obligatory surgical intervention. There can be many different causes of perforation. The aim of this study was to evaluate the unusual causes and the surgical treatment.
In our clinic, we operated 675 patients due to intestinal perforation over a period of six years. Perforation due to brid, trauma, colorectal tumor, mesenteric ischemia, hernias, and iatrogenic injuries were considered as usual causes and excluded from the study. The remaining 37 patients (22 male, 15 female; mean age 53.2; range 25 to 80 years) were analyzed. For statistical analysis, Mann-Whitney U and chi-square tests were used, and p < 0.05 was considered significant.
A localized or generalized peritonitis was the most common symptom. Leukocytosis was found in 18 patients and free abdominal air was seen in 20 patients; bedside ultrasonographic examination was done in 17 patients. The most prevalent etiological factors were non-Hodgkin lymphoma, Crohn disease and internal herniation, respectively. Eight patients died; their time to laparotomy was significantly longer (8.7 days), and half of them had malignant small bowel tumor in perforation etiology.
Mortality and morbidity rates are high in intestinal perforations due to unusual causes. Delayed laparotomy and malignant etiology may be the main factors.
肠穿孔是必须进行外科手术干预的主要原因之一。穿孔可能有许多不同原因。本研究的目的是评估不常见的病因及外科治疗方法。
在我们诊所，6年期间因肠穿孔对675例患者进行了手术。因鸟喙、外伤、结直肠肿瘤、肠系膜缺血、疝和医源性损伤导致的穿孔被视为常见病因并排除在本研究之外。对其余37例患者（男22例，女15例；平均年龄53.2岁；范围25至80岁）进行了分析。采用Mann-Whitney U检验和卡方检验进行统计学分析，p<0.05被认为具有统计学意义。
局限性或全身性腹膜炎是最常见的症状。18例患者出现白细胞增多，20例患者可见腹腔游离气体；17例患者进行了床边超声检查。最常见的病因分别是非霍奇金淋巴瘤、克罗恩病和内疝。8例患者死亡；他们的剖腹手术时间明显更长（8.7天），其中一半患者穿孔病因是恶性小肠肿瘤。
因不常见病因导致的肠穿孔死亡率和发病率较高。剖腹手术延迟和恶性病因可能是主要因素。
