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Right Colonic Perforation in an Asian Population: Predictors of Morbidity and Mortality

Journal of Gastrointestinal Surgery volume 13, Article number: 2252 (2009) Cite this article

Abstract

Introduction

Perforation of the colon is associated with significant morbidity and mortality. Pathologies arising from the right colon differ greatly between Asians and the Western population. The aims of our study were to evaluate the implications of perforated right colon in an Asian population and to identify factors that could predict the perioperative outcome.

Methods

A retrospective review of all patients who underwent operative intervention for peritonitis from right colonic perforation from July 2003 to April 2008 was performed. Patients were identified from the hospital’s diagnostic index and operating records. The severity of abdominal sepsis for all patients was graded using the Mannheim peritonitis index (MPI). All the complications were graded according to the classification proposed by Clavian and colleagues.

Results

Fifty-one patients with a median age of 60 years (range, 22–93 years) formed the study group. Diverticulitis (47.1%) and malignancy (37.3%) accounted for the majority of the pathologies. Right hemicolectomy without diverting stoma (n = 34, 66.7%) was performed most commonly. Of our patients, 74.5% had perioperative morbidity with 19 (37.3%) patients having grade III or worse complications. In our series, five (9.8%) patients died. On univariate analysis, American Society of Anesthesiologists (ASA) score ≥3, ≥2 premorbid conditions, raised MPI, raised creatinine, and stoma creation were related to more severe complications (grade III/IV). The following variables were correlated with in-hospital mortality: ASA score ≥3, raised MPI, hematocrit <33%, raised creatinine, malignant perforation, and stoma creation. On multivariate analysis, a higher ASA score ≥3 was predictive of significant morbidity, while both malignant perforation and stoma creation were associated with mortality.

Conclusion

Diverticulitis is the commonest cause of right colonic perforation in Asians. Patients with higher ASA score and malignant perforation are at risk of higher morbidity and mortality. Resection with primary anastomosis is safe and patients who require stomas are more likely to do worse.

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Affiliations

  1. Department of General Surgery, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore, 308433, Singapore

    Ker-Kan Tan, Junren Zhang, Jody Zhiyang Liu, Sharon Fengli Shen & Richard Sim

  2. Clinical Research Unit, Tan Tock Seng Hospital, Singapore, Singapore

    Arul Earnest

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  1. Ker-Kan Tan
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  2. Junren Zhang
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Correspondence to Ker-Kan Tan.

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Tan, KK., Zhang, J., Liu, J.Z. et al. Right Colonic Perforation in an Asian Population: Predictors of Morbidity and Mortality. J Gastrointest Surg 13, 2252 (2009). https://doi.org/10.1007/s11605-009-0986-4

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  • DOI: https://doi.org/10.1007/s11605-009-0986-4

Keywords

  • Perforation
  • Right colon
  • Outcome
  • Surgery