Journal of Yeungnam Medical Science

Original article

Patient outcomes and prognostic factors associated with colonic perforation surgery: a retrospective study: Do-bin Lee, Seonhui Shin, Chun-Seok Yang; J Yeungnam Med Sci. 2022;39(2):133-140. Published online October 29, 2021; DOI: https://doi.org/10.12701/yujm.2021.01445

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Background
Despite advances in surgery and intensive perioperative care, fecal peritonitis secondary to colonic perforation is associated with high rates of morbidity and mortality. This study was performed to review the outcomes of patients who underwent colonic perforation surgery and to evaluate the prognostic factors associated with mortality.
Methods
A retrospective analysis was performed on 224 consecutive patients who underwent emergency colonic perforation surgery between January 2008 and May 2019. We divided the patients into survivor and non-survivor groups and compared their surgical outcomes.
Results
The most common cause of colon perforation was malignancy in 54 patients (24.1%), followed by iatrogenic perforation in 41 (18.3%), stercoral perforation in 39 (17.4%), and diverticulitis in 37 (16.5%). The sigmoid colon (n=124, 55.4%) was the most common location of perforation, followed by the ascending colon, rectum, and cecum. Forty-five patients (20.1%) died within 1 month after surgery. Comparing the 179 survivors with the 45 non-survivors, the patient characteristics associated with mortality were advanced age, low systolic blood pressure, tachycardia, organ failure, high C-reactive protein, high creatinine, prolonged prothrombin time, and high lactate level. The presence of free or feculent fluid, diffuse peritonitis, and right-sided perforation were associated with mortality. In multivariate analysis, advanced age, organ failure, right-sided perforation, and diffuse peritonitis independently predicted mortality within 1 month after surgery.
Conclusion
Age and organ failure were prognostic factors for mortality associated with colon perforation. Furthermore, right-sided perforation and diffuse peritonitis demonstrated a significant association with patient mortality.

Citations

Citations to this article as recorded by

Colorectal Oncologic Emergencies
Joshua Sullivan, Alec Donohue, Shaun Brown
Surgical Clinics of North America.2024; 104(3): 631. CrossRef
One Year of Experience Managing Peritonitis Secondary to Gastrointestinal Perforation at a Tertiary Care Hospital: A Retrospective Analysis
Muhammad Hasaan Shahid, Faisal I Khan, Zain Askri, Arslan Asad, M. Azhar Alam, Danish Ali, Rabia Saeed, Aun Jamal, Tauseef Fatima, M. Farooq Afzal
Cureus.2022;[Epub] CrossRef
Risk factors for urgent complications of colorectal cancer
S. N. Shchaeva
Pelvic Surgery and Oncology.2022; 12(2): 28. CrossRef

Case Reports

A Case of Continuous Ambulatory Peritonitis Dialysis Peritonitis Due to Stenotrophomonas maltophilia Using Antibiotic Combination.: Hee Sung Ko, Ah Ran Choi, Tae Hoon Kim, Chan Hee Kyung, Jang Ho Cho, Yong Hoon Kim, Jung Eun Lee; Yeungnam Univ J Med. 2013;30(2):109-111. Published online December 31, 2013; DOI: https://doi.org/10.12701/yujm.2013.30.2.109

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Abstract PDF: Continuous ambulatory peritoneal dialysis (CAPD) peritonitis is a major complication of peritoneal dialysis (PD) and leads to the discontinuation of PD. Despite its limited pathogenicity, CAPD peritonitis caused by Stenotrophomonas maltophilia (S. maltophilia), an important nosocomial pathogen that is present in nature and is usually associated with plastic indwelling devices. Infection of S. maltophilia is associated with a poor prognosis, including inability to maintain the CAPD catheter, because of its resistance to multiple antibiotics. We report a case of CAPD peritonitis due to S. maltophilia that was treated successfully using oral Trimethoprim-sulfame-thoxazole and intraperitoneal Ticarcillin/clavulanate without removing the dialysis catheter.

A Case of Pneumatosis Intestinalis in Peritoneal Dialysis Peritonitis.: Sun Young Jung, Ji Hun Na, Yun Jung Choi, Sung Ae Koh, Ku Hyang Choi, Jong Won Park, Jun Young Do, Kyeng Woo Yun; Yeungnam Univ J Med. 2009;26(1):49-55. Published online June 30, 2009; DOI: https://doi.org/10.12701/yujm.2009.26.1.49

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Abstract PDF: Peritonitis is a serious problem in patients undergoing peritoneal dialysis. Rarely pneumatosis intestinalis can occur as a complication of this infectious process. Pneumatosis intestinalis is a potential life threatening condition with a challenging management. The mortality of peritoneal dialysis patients with pneumatosis intestinalis secondary to mesenteric ischemia is almost 100%. We describe a rare case of pneumatosis intestinalis in a peritoneal dialysis patient who developed Staphylococcus aureus peritonitis which was initially treated with appropriate antibiotics. Since initial response to therapy was not achieved, an abdominal computerized tomography was done which revealed a pneumatosis intestinalis. A laparotomy was performed and small bowel necrosis was seen. A segmental resection with ileostomy, jejunostomy was done. Though surgical treatment was performed, the patient died in 2 weeks after admission. Pneumocystitis intestinalis in peritoneal dialysis peritonitis is a uncommon complication which requires prompt evaluation to rule out mesenteric ischemia as it carries a high mortality and its management will be surgical.

Original Article

The Effects of Catheter Revision and Mupirocin on Exit Site Infection/Peritonitis in CAPD Patients.: Jun Beom Park, Jung Mee Kim, Jun Hyuk Choi, Kyu Hyang Jo, Hang Jae Jung, Yeung Jin Kim, Jun Yeung Do, Kyung Woo Yoon; Yeungnam Univ J Med. 1999;16(2):347-356. Published online December 31, 1999; DOI: https://doi.org/10.12701/yujm.1999.16.2.347

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Abstract PDF: BACKGROUND
Exit site/tunnel infection causes cosiderable morbidity and technique failure in CAPD patients. We presently use a unique revision method for the treatment of refractory ESI/TI in CAPD patients and mupirocin prophylaxis for high risk patients. MATERIALS AND METHODS: We reviewed 139 CAPD patients about the ESI/TI from October 1993 to February 1999 at Yeungnam University Hospital. At the beginning of the ESI, we usually started medications with rifampicin and ciprofloxacin and then changed the antibiotics according to the sensitivity test. If the ESI had persisted and there were T1 symptoms(purulent discharge, abscess lesion around exit site), we performed catheter revision(external cuff shaving, disinfection around tunnel and new exit site on opposit direction) with a combination of proper antibiotics. We applied local mupirocin ointment at the exit site three times per week to the 34 patients who had the risk of ESI starting from October 1998. RESULTS: The total follow-up was 2401 patient months(pt. mon). ESI occurred on 105 occasions in 36 out of 139 patients, and peritonitis occurred on 112 occasions in 67 out of 139 patients. The total number of incidences of ESI and peritonitis was 1 per 23.0 pt.mon and 0 per 21.6 pt.mon. The most common organism responsible for ESI was Staphylococcus aureus(26 of 54 isolated cases, 48%), followed by the Methicillin resistant S. auresu(MRSA) (13 cases, 24%). Seven patients(5: MRSA, 2: Pseudomonas) had to be treated with a revision to control infection. Three patients experienced ESI relapse after revision. One of them improved with antibiotics, while another needed a second revision and the remaining required catheter removal due to persistent MRSA infection with re-insertion at the same time. But, there was no more ESI in these 3 patients who were received management to relapse (The mean duration: 14.0 months). The rates of ESI were significantly reduced after using mupirocin than before(1 per 12.7 vs 34.0 pt.mon, p<0.01). CONCLUSION: In summary, revision technique can be regarded as an effective method for refractory ESI/T1 before catheter removal. Also local mupirocin ointment can play a significant role in the prevention of ESI.

Case Report

Three cases of meconium peritonitis.: Young Hwan Lee, Soo Ho Ahn, Son Moon Shin, Young Soo Huh; Yeungnam Univ J Med. 1991;8(1):191-197. Published online June 30, 1991; DOI: https://doi.org/10.12701/yujm.1991.8.1.191

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Abstract PDF: Meconium peritonitis is an aseptic peritonitis caused by spill of meconium in the abdominal cavity through one or several intestinal perforations which have taken place during intrauterine life or early neonatal life. We experienced three cases of meconium peritonitis with ileal perforation in two cases 1 day-old male neonate and 2 day-old male neonate, respectively, which had the chief complaint of vomiting and abdominal distension. Literatures are reviewed, briefly.

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