Prognostic Factors in Patients with Colorectal Perforation

• Published in: Nippon Shokaki Geka Gakkai zasshi Vol. 41; no. 6; pp. 605 - 611
• Main Authors: Nagata, Hiroaki, Nakashima, Susumu, Fukuda, Ken-ichiro, Kinoshita, Osamu, Masuyama, Mamoru, Furutani, Akinobu
• Format: Journal Article
• Language: Japanese
• Published: The Japanese Society of Gastroenterological Surgery 2008
• Subjects: colorectal perforation; endotoxin adsorption therapy (PMX-DHP); septic shock
• ISSN: 0386-9768; 1348-9372
• DOI: 10.5833/jjgs.41.605

Background: Unless recognized and treated promptly, colorectal perforation easily causes septic shock and life-threatening complications. We studied prognostic factors in patients with colorectal perforation. From April 1995 to March 2007, 38 patients with colorectal perforation underwent emergency surgery documented in Surgery Department files at our institution. Methods: Subjects were retrospectively divided into survivors (n=29) and nonsurvivors (n=9). We studied their clinical factors, and compared mortality for each factor. Results: Overall mortality was 23.7%(9/38). The underlying disease included colorectal cancer in 10 cases, diverticulitis in 9 cases, idiopathic disease in 8 cases, iatrogenic disease in 7 cases, abdominal trauma in 2 cases, and others in 2 cases. Mortality was high in cancer at 30%(3/10) and idiopathic disease at 50%(4/8). Most surgery involved Hartmann's technique (n=19). Mortality in patients with base excess≤-5 was 53.8%(P=0.023), with APACHE II score≥20 was 80%(P=0.007), and with renal complications was 100%(P=0.001), making these factors statistically significant, respectively. Mortality in 16 patients undergoing postoperative endotoxin absorption therapy (PMX-DHP) was 43.8%(7/16). In PMX-DHP, urinary output significantly increased from 61.0±61.0ml/h to 127.6±98.1ml/h (P=0.038). This is more likely to occur strongly among survivors (P=0.06). Discussion: Base excess, APACHE II score and renal complications are prognostic factors in patients with colorectal perforation. The usefulness of PMX-DHP is still controversial.