Деякі причини перфорації шлунково-кишкового тракту

Perforation Site

Cause

Comments

All sites

Trauma

Foreign bodies

Esophagus

Forceful vomiting

Termed Boerhaave syndrome

Iatrogenic causes

Typically perforation with an esophagoscope, balloon dilator, or bougie

Ingestion of corrosive material

Stomach or duodenum

Peptic ulcer disease

Can occur in patients with no previous history of ulcer symptoms

Sometimes no free air is visible on radiograph

Ingestion of corrosive material

Typically stomach

Intestine

Strangulating obstruction

Possibly acute appendicitis and Meckel diverticulitis

Free air rarely visible on radiographs

Colon

Obstruction

Typically perforates at cecum

High risk: Colon ≥ 13 cm diameter, patients receiving prednisone or other immunosuppressants (symptoms and signs may be minimal in this group)

Diverticulitis

Inflammatory bowel disease (ulcerative colitis, Crohn disease)

Toxic megacolon

Sometimes spontaneous

Gallbladder

Iatrogenic injury during cholecystectomy or liver biopsy

Usually the biliary tree or duodenum is injured

Rarely, acute cholecystitis

Usually walled off by omentum