Patient outcomes and prognostic factors associated with colonic perforation surgery: a retrospective study

Evaluation of Morbidity and Mortality in Iatrogenic Colonic Perforation During Colonoscopy: A Comprehensive Systematic Review and Meta-Analysis

This systematic review and meta-analysis explores the clinical and patient-specific factors contributing to increased morbidity and mortality following iatrogenic colonic perforation (ICP) during routine colonoscopy. A comprehensive search of Scopus, PubMed (Medline), Embase, and Google Scholar was conducted, reviewing studies published between 2010 and 2024. Data were synthesized through thematic analysis for qualitative data and meta-analysis for quantitative outcomes. This study found the overall perforation rate during colonoscopy to be between 0.019% and 0.66%. The average age of patients was 68.91 years. The mortality rate was approximately 11%. Older patients had a higher risk of perforation and an increased mortality rate. Therapeutic colonoscopy carries a significantly higher risk of perforation compared to diagnostic colonoscopy. Diagnostic colonoscopies were more likely to cause larger perforations, which, in turn, carry greater morbidity than smaller perforations. The most common sites of perforation are the sigmoid colon and the rectosigmoid junction. The leading causes of perforation include diverticulitis, malignancy, abnormal sigmoid anatomy, and inflammatory bowel disease. About half of the perforations were discovered during or immediately after the procedure. The most common surgical interventions were resection with primary anastomosis and Hartmann's procedure. Operators with limited experience were more likely to cause perforations and experience delayed recognition of the issue. The results suggest that both clinical and patient-specific factors play critical roles in determining outcomes for patients experiencing ICP during routine colonoscopy. Early detection, timely intervention, and operator experience are key to improving patient survival and reducing complications. Furthermore, the study highlights the need for ongoing research to refine patient selection criteria and enhance postoperative care protocols, particularly for high-risk populations such as the elderly and those with significant comorbidities. This review underscores the importance of heightened vigilance in colonoscopy procedures, especially among vulnerable populations. Future research should focus on improving diagnostic protocols and treatment strategies to minimize the risks associated with ICP and enhance patient safety in routine colonoscopy practices.

Risk Factors for Postoperative Major Morbidity, Anastomotic Leakage, Re-Surgery and Mortality in Patients with Colonic Perforation

Background/Objectives: This study aimed to determine the risk factors associated with postoperative major morbidity, anastomotic/suture leakage, re-surgery and mortality in patients undergoing emergency surgery for colonic perforation. Methods: A total of 204 adult patients treated surgically for colonic perforation from 2016 to 2021 at the University Hospital Erlangen were included in a retrospective analysis. Patient demographics and pre-, intra- and postoperative parameters were obtained and evaluated among various outcome groups (in-hospital major morbidity, anastomotic/suture leakage, re-surgery and 90-day mortality). Results: Postoperative in-hospital major morbidity, anastomotic/suture leakage, need of re-surgery and 90-day mortality occurred in 45%, 12%, 25% and 12% of the included patients, respectively. Independent risk factors for in-hospital major morbidity were identified and included the presence of any comorbidity, a significantly reduced preoperative general condition, the localization of perforation in the right hemicolon and the need for an intraoperative blood transfusion. The only independent risk factor for anastomotic/suture leakage was the presence of any comorbidity, whereas no independent risk factors for re-surgery were found. An age > 65 years, a significantly reduced preoperative general condition and the need for an intraoperative blood transfusion were independent risk factors for 90-day mortality. Conclusions: Our study identified risk factors impacting postoperative outcomes in patients undergoing emergency surgery for colonic perforation. These patients should receive enhanced postoperative care and may benefit from individualized and targeted therapeutic approaches.

Colorectal Oncologic Emergencies: Recognition, Management, and Outcomes

Colorectal cancer is the third most frequent type of malignancy in the United States, and the age at diagnosis is decreasing. Although the goal of screening is focused on prevention and early detection, a subset of patients inevitably presents as oncologic emergencies. Approximately 15% of patients with colorectal cancer will present as surgical emergencies, with the majority being due to either colonic perforation or obstruction. Patients presenting with colorectal emergencies are a challenging cohort, as they often present at an advanced stage with an increase in T stage, lymphovascular invasion, and metachronous liver disease.

One Year of Experience Managing Peritonitis Secondary to Gastrointestinal Perforation at a Tertiary Care Hospital: A Retrospective Analysis

Introduction

Peritonitis secondary to gastrointestinal perforation causes high morbidity and mortality rates in the emergency department with an immediate need for surgical intervention. Despite improved surgical management procedures, patients are still suffering from gastrointestinal leak causing peritonitis that demands surgical management by highly skilled surgeons in high-quality surgical units.

Material and methods

This paper presents one year of experience in the surgical treatment of gastrointestinal perforation-related peritonitis by surgeons in Lahore General Hospital, Lahore, Pakistan. Data was retrospectively collected from patient records and quantitatively analyzed. Involved patients developed peritonitis secondary to gastrointestinal perforation requiring surgical exploration and interventions in the emergency department between November 2020 and October 2021.

Results

One hundred and fifty-eight patients were involved; the mean age was 43.46 years. The number of males was 87 (55.06%). The patients mostly presented with generalized abdominal pain (57.6%). All the patients had perforation-related peritonitis, which was most prevalent in the ileum (62%). The most performed surgical intervention was loop ileostomy (36.71%). Compared to other published reports, the incidence rate of wound dehiscence in the hospital was relatively higher. Postoperatively, wound infection was low if the skin was left open (23.62%) compared to closed skin (38.7%). Patient outcomes were acceptable as the death rate was low (3.2%, 5/158).

Conclusion

Peritonitis caused by gastrointestinal perforation is associated with a high risk of morbidity that necessitates surgical exploration. Leaving skin wound open after the surgical intervention is recommended to decrease the incidence of wound infection and dehiscence.