Unusual causes of intestinal perforation and their surgical treatment

BACKGROUND
Intestinal perforation is one of the major causes of obligatory surgical intervention. There can be many different causes of perforation. The aim of this study was to evaluate the unusual causes and the surgical treatment.
METHODS
In our clinic, we operated 675 patients due to intestinal perforation over a period of six years. Perforation due to brid, trauma, colorectal tumor, mesenteric ischemia, hernias, and iatrogenic injuries were considered as usual causes and excluded from the study. The remaining 37 patients (22 male, 15 female; mean age 53.2; range 25 to 80 years) were analyzed. For statistical analysis, Mann-Whitney U and chi-square tests were used, and p<0.05 was considered significant.
RESULTS
A localized or generalized peritonitis was the most common symptom. Leukocytosis was found in 18 patients and free abdominal air was seen in 20 patients; bedside ultrasonographic examination was done in 17 patients. The most prevalent etiological factors were non-Hodgkin lymphoma, Crohn disease and internal herniation, respectively. Eight patients died; their time to laparotomy was significantly longer (8.7 days), and half of them had malignant small bowel tumor in perforation etiology.
CONCLUSION
Mortality and morbidity rates are high in intestinal perforations due to unusual causes. Delayed laparotomy and malignant etiology may be the main factors.

Baðýrsak delinmelerinin nadir nedenleri ve cerrahi tedavisi

AMAÇ
Baðýrsak delinmeleri, acil cerrahi giriþim gerektiren patolojilerin önde gelenlerindendir. Çok çeþitli nedenleri vardýr. Bu çalýþmada, ender görülen nedenleri ve cerrahi tedavi yöntemleri deðerlendirildi.
GEREÇ VE YÖNTEM
Kliniðimizde altý yýllýk süre içerisinde baðýrsak delinmesi nedeniyle 675 hasta ameliyat edildi. Yapýþýklýklara, travma, kolorektal tümör, mezenter vasküler hastalýk, inguinal fýtýklar, göbek fýtýklarý ve iyatrojenik yaralanmalara baðlý delinmeler olaðan sebeplere baðlý kabul edilerek çalýþmaya dahil edilmedi. Geri kalan 37 hasta (22 erkek, 15 kadýn; ortalama yaþ 53,2; daðýlým 25-80 yaþ) incelendi. Hayatýný kaybeden ve yaþayan hastalar arasýndaki karþýlaþtýrmalar için Mann-Whitney U ve ki-kare testleri kullanýldý, p<0,05 deðeri anlamlý kabul edildi.
BULGULAR
Bölgesel veya yaygýn peritonit en sýk saptanan inceleme bulgusuydu. Lökositoz 18 hastada vardý, karýnda serbest hava 20 hastada görüldü, hasta baþý ultrasonografik inceleme 17 hastada yapýldý. Etyolojide sýrasýyla en sýk non-Hodgkin lenfoma, Crohn ve internal herniasyon saptandý. Hastalarýn sekizi yaþamýný yitirdi. Hayatýný kaybeden hastalarda laparotomi zamaný anlamlý olarak daha uzundu (8,7 gün) ve yarýsýnda delinme nedeni habis ince baðýrsak tümörüydü.
SONUÇ
Ender nedenli olarak geliþen baðýrsak delinmelerinin morbidite ve mortalitesi yüksektir. Gecikmiþ cerrahi giriþim ve nedenin habis bir hastalýk olmasý en önemli etkenleri olabilir.