Clinical features and treatment analysis of acute lower gastrointestinal perforation in the elderly
Objective:By analyzing the etiology,clinical features,surgical methods and curative effects of low-er digestive tract perforation in the elderly,it provides reference for clinical treatment of this disease.Methods:A total of 54 elderly patients with acute lower gastrointestinal perforation admitted to the emergency department of our hospital from January 2018 to June 2023 were enrolled.The retrospective analysis method was adopted to di-vide the patients into small bowel perforation group and colorectal perforation group according to different parts of the digestive tract perforation,and the general information,auxiliary examinations,etiology,treatment plan and outcome of the two groups of patients were analyzed.Results:A total of 20 cases of small intestine perforation were caused by foreign body in 9 cases,lymphoma in 4 cases,unknown cause in 4 cases,diverticulitis in 2 cases and inflammatory bowel disease in 1 case.There were 34 cases of colorectal perforation,which were caused by co-lon tumors in 19 cases,fecal lithosity in 6 cases,iatrogenic in 5 cases,diverticulitis in 3 cases,and foreign body in 1 case.The positive rate of CT examination in both groups was 100％.The colorectal group had higher inflamma-tory indexes and lactic acid levels than the small intestine group.All patients with small bowel perforation were cured by repair or anastomosis after bowel resection,and 2 cases were complicated by incision infection and 1 case of residual abscess in the abdominal cavity.In the colorectal group,6 cases(5 cases of iatrogenic perforation and 1 case of diverticulum perforation)were repaired,and 16 cases of lesion bowel resection and stage Ⅰ anastomosis were performed,lesion resection and enterostomy in 8 cases,only enterostomy in 4 cases,28 cases were cured in the rectal group,6 cases died,and 6 cases were infected by incision.Conclusion:Foreign body is one of the main causes of small bowel perforation in the elderly,tumor is the most important cause of colorectal perforation,and colorectal perforation caused by fecal stone and iatrogenic also accounts for a high proportion.Abdominal CT posi-tivity is high and may be preferred as an adjunct.It is safe for perforation of the small intestine,perforation of the right half colon and diverticulitis,iatrogenic perforation,and resectable tumor perforation repair or stage Ⅰ anasto-mosis after resection without severe malnutrition,hypoproteinemia,and good intestinal blood supply.
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