GI perforation Flashcards
Where can GI perforation happen?
can occur any anatomical location from upper oesophagus to anorectal junction
What is the aetiology of GI perforation?
- Diverticulitis
- PUD
- Gastric/colorectal malignancy
- Iatrogenic e.g. routine endoscopy
- Trauma
- Foreign body
- Appendicitis or Meckel’s diverticulitis
- Mesenteric ischaemia
- Obstructing lesions
- Serve colitis
- Excessive vomiting
What is the presentation of GI perforation?
- Rapid onset abdominal pain
- Features of sepsis
- Features of peritonism (localised or generallised)
What is a thoracic perforation?
any thoracic region perforation e.g. oesophageal rupture present with pain, ranging from chest or neck pain to pain radiating to back, typically worsening on inspiration
What is throacic perforation associated with?
vomiting and respiratory symptoms
What can thoracic perforation show O/E?
auscultation may reveal signs of pleural effusion with potential for palpable crepitus
What bloods are done for GI perforation?
- FBC
- U+Es
- LFTs
- CRP
- Clotting
What imaging is done for GI perforation?
- CT: gold standard
- Erect CXR
- AXR
What would CT show in GI perforation?
gold standard for perforation – confirming presence of free air and suggesting location of perforation (and possible underlying cause)
What can erect CXR show in GI perforation?
can show air under diaphragm in cases of pneumoperitoneum
What can AXR show in GI perforation?
show riglers sign (both sides of bowel visible) or psoas sign (loss of sharp delineation of psoas muscle border)
What is the management for GI perforation?
- ABCDE
- Broad spectrum antibiotics
- NBM
- Adequate fluid resus and appropriate analgesia
- Most patient with perforated viscus will require theatre for repair and control of contamination
What does the surgical intervention involve for GI perforation?
- Identification of underlying cause
- Appropriate management of perforation
- Thorough washout
When would conservative management be appropriate in GI perforation?
- Localised diverticular perforation with only localised peritonitis and tenderness, and no evidence of generalised contamination on imaging
- Patients with a sealed upper GI perforation on CT imaging without generalised peritonism
- Elderly frail patients with extensive co-morbidities who would be very unlikely to survive surgery
