Acute Perforation

Acute perforation can occur in all parts of the gastrointestinal tract. As a result of perforation of the stomach or intestinal contents from entering the peritoneal cavity. The causes are many. Symptoms occur suddenly, with severe pain, immediately followed by circulatory shock. The diagnosis is usually made using the abdomen of imaging by the detection of free air. The treatment consists of fluid replacement, antibiotics and surgery. Mortality is high, it depends on the underlying disease and general condition of the patient.

Acute perforation can occur in all parts of the gastrointestinal tract. As a result of perforation of the stomach or intestinal contents from entering the peritoneal cavity. The causes are many. Symptoms occur suddenly, with severe pain, immediately followed by circulatory shock. The diagnosis is usually made using the abdomen of imaging by the detection of free air. The treatment consists of fluid replacement, antibiotics and surgery. Mortality is high, it depends on the underlying disease and general condition of the patient. lead etiology A blunt and penetrating trauma to a perforation in all parts of the gastrointestinal tract (s. Some causes of a perforation of the gastrointestinal tract). Ingested foreign body, even if they are sharp, rarely cause perforation, unless they are impacted, leading to ischemia and necrosis by local pressure (overview of foreign bodies in the gastrointestinal tract). About the anus introduced foreign bodies the rectum or sigmoid perforate. Some causes of a perforation of the gastrointestinal tract perforation cause Comments All positions trauma – foreign bodies – esophageal Powerful suction vomiting. Boerhaave syndrome iatrogenic causes Typically, perforation with a esophagoscope, balloon catheters or bougie ingestion of corrosive material – stomach or duodenum Peptic ulcer disease in approximately one third of patients had no history of Ulkussymptomen At about 20% no free air visible on the X-ray image ingestion of corrosive material typically stomach Intestinal strangulation – Possibly acute appendicitis and Meckel diverticulitis free air rarely visible on the radiograph colon closure Typically perforated in the cecum High risk: Colon> 13 cm in diameter, patients who (may be minimal symptoms and complaints in this group) prednisone or other immunosuppressive agents get diverticulitis – Inflammatory bowel disease (ulcerative colitis, Crohn’s disease) – Toxic megacolon – sometimes spontaneously – Iatrogenic gall bladder injury during cholecystectomy or liver biopsy are usually the biliary tract or the duodenum injured Rarely acute cholecystitis usually from the surrounding network envelops Symptoms and complaints The perforation of the esophagus, stomach and duodenum occurs suddenly and is catastrophic, with abrupt occurrence of an acute abdomen with severe abdominal pain and signs of peritoneal irritation (Acute abdominal pain: peritonitis). The pain may radiate to the shoulders. Perforations in other parts of the gastrointestinal tract evoke other pain and inflammation symptoms usually. Because such perforations are often small initially and be surrounded by the network, the pain is slow to develop and remains localized. The abdominal wall usually show only focal tenderness. These findings make it difficult to distinguish between a perforation of a worsening of the underlying disease or the lack of response to treatment. In all perforations nausea, vomiting and anorexia occur. Bowel sounds are reduced or absent. Diagnosis Abdomenübersichtsaufnahmen If not diagnostic, abdominal CT Abdomenübersichtsaufnahmen (in horizontal and vertical position abdomen and chest scans) may already be diagnostic and, at 50-75% of patients free air under the diaphragm. In the course of the disease this character is more obvious. A lateral radiograph is more sensitive than a posteroanteriores in diagnostics. If the survey radiographs not lead to the diagnosis, an abdominal CT with oral and iv and / or rectal contrast media to be useful. Barium should not be used if a perforation is suspected. Free air Figure provided by Parswa Ansari, M.D. var model = {thumbnailUrl: ‘/-/media/manual/professional/images/free_air_high_de.jpg?la=de&thn=0&mw=350’ imageUrl: ‘/-/media/manual/professional/images/free_air_high_de.jpg?la = en & thn = 0 ‘, title:’: u003Ca id = “v38395131 ” class = “”anchor “” u003e u003c / a u003e u003cdiv class = “”para “” Free air ‘description’ u003e u003cp u003eRöntgenaufnahme of Abdomes with the open air

Health Life Media Team

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