Classification und Treatment Algorithm of Small Bowel Perforations Based on a Ten-Year Retrospective Analysis

Background: Small bowel perforations are a rare diagnosis compared with esophageal, gastric, and colonic perforations. However, small bowel perforations can be fatal if left untreated. A classification of small bowel perforations or treatment recommendations do not exist to date. Methods: A retrospe...

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Published inJournal of clinical medicine Vol. 11; no. 19; p. 5748
Main Authors Onken, Flurina, Senne, Moritz, Königsrainer, Alfred, Wichmann, Dörte
Format Journal Article
LanguageEnglish
Published Basel MDPI AG 28.09.2022
MDPI
Subjects
Abdomen
Antibiotics
Cancer
Classification
Data analysis
Endoscopy
Hospitals
Ischemia
Laparoscopy
Length of stay
Localization
Medical prognosis
Metastasis
Morbidity
Mortality
Patients
Sepsis
Small intestine
Germany
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ISSN2077-0383
2077-0383
DOI10.3390/jcm11195748

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Summary:Background: Small bowel perforations are a rare diagnosis compared with esophageal, gastric, and colonic perforations. However, small bowel perforations can be fatal if left untreated. A classification of small bowel perforations or treatment recommendations do not exist to date. Methods: A retrospective, monocentric, code-related data analysis of patients with small bowel perforations was performed for the period of 2010 to 2019. Results: Over a 10-year period, 267 cases of small bowel perforation in 257 patients (50.2% male and 49.8% female; mean age of 60.28 years) were documented. Perforation’s localization was 5% duodenal, 38% jejunal, 39% ileal, and 18% undocumented. Eight etiologies were differentiated: iatrogenic (41.9%), ischemic (20.6%), malignant (18.9%), inflammatory (8.2%), diverticula-associated (4.5%), traumatic (4.5%), foreign-body-associated (1.9%), and cryptical (1.5%) perforations. Operative treatment combined with antibiotics was the most commonly used therapeutic approach (94.3%). The mortality rate was 14.23%, with highest rate for patients with ischemic perforations. Discussion: An algorithm for diagnostic and therapeutic steps was established. Furthermore, it was found that small bowel perforations are rare events with poor outcomes. Time to diagnosis and grade of underlying disease are the most essential parameters to predict perforation-associated complications.
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ISSN:2077-0383
2077-0383
DOI:10.3390/jcm11195748