Assessment of Predictors of Mortality and Severity in Patients with Colorectal Perforation

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  • Egashira Akinori
    Department of Molecular Oncology, Graduate School of Medical Sciences, Kyushu University
  • Iguchi Tomohiro
    Department of Surgery, Fukuoka-Higashi Medical Center
  • Nozoe Tadahiro
    Department of Surgery, Fukuoka-Higashi Medical Center
  • Adachi Eisuke
    Department of Surgery, Fukuoka-Higashi Medical Center
  • Matsukuma Akito
    Department of Surgery, Fukuoka-Higashi Medical Center
  • Ezaki Takahiro
    Department of Surgery, Fukuoka-Higashi Medical Center
  • Kakeji Yoshihiro
    Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University
  • Tsujitani Shunichi
    Department of Innovative Applied Oncology, Graduate School of Medical Sciences, Kyushu University
  • Maehara Yoshihiko
    Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University

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Other Title
  • 大腸穿孔症例における死亡率及び重症度予測因子についての検討

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Abstract

Colorectal perforation is a life-threatening disease with high mortality and morbidity. The correct and prompt diagnosis and accurate judgment of severity are necessary. We retrospectively investigated 30 patients with colorectal perforation to assess predictors of mortality and severity, and evaluated the usefulness of computed tomography (CT) for the initial diagnosis. The severity of peritonitis was assessed using clinical factors and Physiological and Operative Severity Score for the enUmeration of Mortality and morbidity (POSSUM) scores. Abdominal free air was detected by CT in 92% of patients with colorectal perforation, whereas only 36.6% showed evidence of abdominal free air by conventional radiography. The perforation site was correctly diagnosed in 14 of 25 cases (56%). Overall mortality was 16. 7%. Survivors were younger than nonsurvivors, and POSSUM physiological and mortality scores were significantly lower for survivors compared with nonsurvivors. The amount of intraperitoneal soiling by large bowel content determined disease severity in terms of the need for postoperative respiratory management. In conclusion, CT is necessary for precise diagnosis, and the POSSUM score is helpful for the evaluation of disease mortality and severity.

Journal

  • 福岡醫學雜誌

    福岡醫學雜誌 102 (3), 56-65, 2011-03-25

    Fukuoka Medical Association

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