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Optimal treatment and complications of patients with the perforated upper gastrointestinal tract

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Abstract

Purpose

The perforation of the upper gastrointestinal tract is still associated with a high risk of complications and mortality. We aimed to evaluate the optimal treatment and post-treatment complications for this condition.

Methods

This was a retrospective, single-center study conducted between 2010 and 2019. We analyzed 50 patients with intraperitoneal free air caused by peptic ulcer (44 cases) or cancer (six cases).

Results

All patients initially received either conservative therapy (n = 7) or surgery (n = 43). The nonsurgically cured patients were significantly younger and had mild peritonitis and also had a shorter hospital stay. Two patients were converted to surgery due to worsening symptoms, and one of them was elderly and had a long perforation-to-treatment time. Regarding postoperative complications, patients with Grade II–V (n = 21) were significantly older and had a poorer physical status, longer perforation-to-surgery time, and higher preoperative CRP and lactate than those with Grade 0–I (n = 24). Multivariable analyses identified elevated preoperative lactate as an independent risk factor for postoperative complications. The patients with noncurative surgery for perforated advanced gastric cancer all died within 1 year after surgery.

Conclusions

Consideration should be given to the nonsurgical indications in elderly and delayed treatment patients and the postoperative outcomes of patients with preoperatively elevated lactate levels.

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Acknowledgements

We would like to thank Editage (www.editage.com) for English language editing.

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Authors and Affiliations

  1. Department of Surgery, Kinan Hospital, 46-70 Shinjo, Tanabe, Wakayama, 646-8588, Japan

    Takahito Sugase, Toshiya Michiura, Shoichiro Urabe, Kazuki Sasaki, Nobuyasu Hayashi & Kazuo Yamabe

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  1. Takahito Sugase
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  2. Toshiya Michiura
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  3. Shoichiro Urabe
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  4. Kazuki Sasaki
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  5. Nobuyasu Hayashi
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  6. Kazuo Yamabe
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Corresponding author

Correspondence to Takahito Sugase.

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Sugase T and the other co-authors have no conflicts of interest to declare.

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595_2021_2247_MOESM4_ESM.pdf

Supplementary file4 Supplemental Fig. 1 Participant flow diagram. Sixty-two consecutive patients who were diagnosed with a perforation of the upper gastrointestinal tract, stomach, or duodenum between 2010 and 2019 were identified from the electronic database at Kinan Hospital. The patients with retroperitoneal air (n=10), intestinal wall air (n=1), and those receiving best supportive care for advanced gastric cancer (n=1) were excluded; finally, the remaining 50 patients with intraperitoneal free air were analyzed. All patients received initial inpatient treatment that was categorized as either surgery (n = 43, 86%) or conservative therapy (n = 7, 14%) (PDF 14 KB)

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Sugase, T., Michiura, T., Urabe, S. et al. Optimal treatment and complications of patients with the perforated upper gastrointestinal tract. Surg Today 51, 1446–1455 (2021). https://doi.org/10.1007/s00595-021-02247-z

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  • DOI: https://doi.org/10.1007/s00595-021-02247-z

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