関: intestinal perforation

WordNet

something curved in shape (同)arc
play on a string instrument with a bow
a knot with two loops and loose ends; used to tie shoelaces (同)bowknot
front part of a vessel or aircraft; "he pointed the bow of the boat toward the finish line" (同)fore, prow, stem
a decorative interlacing of ribbons
a slightly curved piece of resilient wood with taut horsehair strands; used in playing certain stringed instruments
a stroke with a curved piece of wood with taut horsehair strands that is used in playing stringed instruments
a weapon for shooting arrows, composed of a curved piece of resilient wood with a taut cord to propel the arrow
bending the head or body or knee as a sign of reverence or submission or shame or greeting (同)bowing, obeisance
an appearance by actors or performers at the end of the concert or play in order to acknowledge the applause of the audience (同)curtain_call
bend ones knee or body, or lower ones head; "He bowed before the King"; "She bowed her head in shame" (同)bow down
bend the head or the upper part of the body in a gesture of respect or greeting; "He bowed before the King"
a line of small holes for tearing at a particular place
the act of punching a hole (especially a row of holes as for ease of separation)
a hole made in something; "a perforation of the eardrum"
the center of the Earth

PrepTutorEJDIC

『弓』 / (楽器の)弓 / 弓形,弓形のもの(にじなど) / (リボンなどの)ちょう結び;ちょうネクタイ(bowtie) / (めがねの)つる / 〈バイオリンなど〉'を'弓でひく
(…に)『身をかがめる』,頭をさげる,おじぎをする《+『down』『to』+『名』》 / (…に)屈服する,従う《+『to』+『名』》 / 〈ひざ・腰〉'を'かがめる,(頭など)'を'さげる / …'を'曲げる / 〈感謝など〉'を'おじぎをして示す / …'を'身をかがめて案内する / おじぎ,えしゃく
《時に複数形で;単数扱い》(ボート・船・飛行機の)『先端部』;へさき,機取 / ベートの最前部のオール;そのこぎ手
〈U〉穴をあけること / 〈C〉《しばしば複数形で》穴,ミシン目,切り取り線
〈C〉『腸』;《通例複数形で》腹わた,内臓 / 《複数形で》内部,中心部

Wikipedia preview

出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2016/10/06 20:29:59」(JST)

wiki en

Gastrointestinal perforation, also known as ruptured bowel, is a hole in the wall of part of the gastrointestinal tract.^[2] The gastrointestinal tract includes the esophagus, stomach, small intestine, and large intestine.^[2]^[1] Symptoms include severe abdominal pain and tenderness.^[2] When the hole is in the stomach or early part of the small intestine the onset of pain is typically sudden while with a hole in the large intestine onset may be more gradual.^[2] The pain is usually constant in nature.^[2] Sepsis, with an increased heart rate, increased breathing rate, fever, and confusion may occur.^[2]

The cause can include trauma such as from a knife wound, eating a sharp object, or a medical procedure such as colonoscopy, bowel obstruction such as from a volvulus, colon cancer, or diverticulitis, stomach ulcers, ischemic bowel, and a number of infections including C. difficile.^[2] A hole allows intestinal contents to enter the abdominal cavity.^[2] The entry of bacteria results in a condition known as peritonitis or in the formation of an abscess.^[2] A hole in the stomach can also lead to a chemical peritonitis due to gastric acid.^[2] A CT scan is typically the preferred method of diagnosis; however, free air from a perforation can often be seen on plain X-ray.^[2]

Perforation anywhere along the gastrointestinal tract typically requires emergency surgery in the form of an exploratory laparotomy.^[2] This is usually carried out along with intravenous fluids and antibiotics.^[2] A number of different antibiotics may be used such as piperacillin/tazobactam or the combination of ciprofloxacin and metronidazole.^[3]^[4] Occasionally the hole can be sewn closed while other times a bowel resection is required.^[2] Even with maximum treatment the risk of death can be as high as 50%.^[2] A hole from a stomach ulcer occurs in about 1 per 10,000 people per year, while one from diverticulitis occurs in about 0.4 per 10,000 people per year.^[5]^[1]

Signs and symptoms

Sudden pain in the epigastrium to the right of the midline indicates perforation of a duodenal ulcer. In a gastric ulcer perforation creates a history of burning pain in epigastrium, with flatulence and dyspepsia. A history of drug intake with insufficient food intake may be present.

In intestinal perforation pain starts from the site of perforation and spreads across the abdomen.

Gastrointestinal perforation results in severe abdominal pain intensified by movement, nausea, vomiting and hematemesis. Later symptoms include fever and or chills.^[6]

In any case, the abdomen becomes rigid with tenderness and rebound tenderness. After some time the abdomen becomes silent and heart sounds can be heard all over. Patient stops passing flatus and motion, abdomen is distended.

The symptoms of esophageal rupture may include sudden onset chest pain.

Causes

Underlying causes include gastric ulcers, duodenal ulcers, appendicitis, gastrointestinal cancer, diverticulitis, inflammatory bowel disease, superior mesenteric artery syndrome, trauma and ascariasis. Typhoid fever,^[7] non-steroidal anti-inflammatory drugs,^[8]^[9] ingestion of corrosives may also be responsible.^[10]

Diagnosis

On x-rays, gas may be visible in the abdominal cavity. Gas is easily visualized on x-ray while the patient is in an upright position. The perforation can often be visualised using computed tomography. White blood cells are often elevated.

Treatment

Surgical intervention is nearly always required in form of exploratory laparotomy and closure of perforation with peritoneal wash. Occasionally they may be managed laparoscopically.^[11]

Conservative treatment including intravenous fluids, antibiotics, nasogastric aspiration and bowel rest is indicated only if the person is nontoxic and clinically stable.^{[citation needed]}

References

^ ^a ^b ^c Domino, Frank J.; Baldor, Robert A. (2013). The 5-Minute Clinical Consult 2014. Lippincott Williams & Wilkins. p. 1086. ISBN 9781451188509. Retrieved 4 August 2016.
^ ^a ^b ^c ^d ^e ^f ^g ^h ⁱ ^j ^k ^l ^m ⁿ ^o Langell, JT; Mulvihill, SJ (May 2008). "Gastrointestinal perforation and the acute abdomen.". The Medical clinics of North America. 92 (3): 599–625, viii–ix. PMID 18387378.
^ Wong, PF; Gilliam, AD; Kumar, S; Shenfine, J; O'Dair, GN; Leaper, DJ (18 April 2005). "Antibiotic regimens for secondary peritonitis of gastrointestinal origin in adults.". The Cochrane database of systematic reviews (2): CD004539. PMID 15846719.
^ Wilson, William C.; Grande, Christopher M.; Hoyt, David B. (2007). Trauma: Resuscitation, Perioperative Management, and Critical Care. CRC Press. p. 882. ISBN 9781420015263.
^ Yeo, Charles J.; McFadden, David W.; Pemberton, John H.; Peters, Jeffrey H.; Matthews, Jeffrey B. (2012). Shackelford's Surgery of the Alimentary Tract (7 ed.). Elsevier Health Sciences. p. 701. ISBN 1455738077.
^ Ansari, Parswa. "Acute Perforation". Merck Manuals. Retrieved June 30, 2016.
^ Sharma AK, Sharma RK, Sharma SK, Sharma A, Soni D (2013). "Typhoid Intestinal Perforation: 24 Perforations in One Patient". Ann Med Health Sci Res. 3 (Suppl1): S41–S43. doi:10.4103/2141-9248.121220. PMC 3853607.
^ R I Russell (2001). "Non-steroidal anti-inflammatory drugs and gastrointestinal damage—problems and solutions". Postgrad Med J. 77 (904): 82–88. doi:10.1136/pmj.77.904.82.
^ Carlos Sostres; Carla J Gargallo; Angel Lanas (2013). "Nonsteroidal anti-inflammatory drugs and upper and lower gastrointestinal mucosal damage". Arthritis Res Ther. 15 (Suppl 3): S3. doi:10.1186/ar4175. PMC 3890944.
^ Ramasamy, Kovil; Gumaste, Vivek V. (2003). "Corrosive Ingestion in Adults". Journal of Clinical Gastroenterology:. 37 (2): 119–124.
^ Rustagi, T; McCarty, TR; Aslanian, HR (2015). "Endoscopic Treatment of Gastrointestinal Perforations, Leaks, and Fistulae.". Journal of clinical gastroenterology. 49 (10): 804–9. PMID 26325190.

External links

Gastrointestinal perforation—MedlinePlus

UpToDate Contents

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1. 救急外来における成人の腹痛の評価 evaluation of the adult with abdominal pain in the emergency department
2. 新生児の自然発生的な腸管穿孔 spontaneous intestinal perforation of the newborn
3. 婦人科腹腔鏡下手術の合併症 complications of gynecologic laparoscopic surgery
4. 消化性潰瘍の合併症の概要 overview of the complications of peptic ulcer disease
5. 婦人科外科手術の合併症 complications of gynecologic surgery

English Journal

Neoadjuvant Chemotherapy Followed by Maintenance Therapy With or Without Bevacizumab in Unresectable High-Grade Serous Ovarian Cancer: A Case-Control Study.

Petrillo M1, Paris I, Vizzielli G, Amadio G, Cosentino F, Salutari V, Scambia G, Fagotti A.
Annals of surgical oncology.Ann Surg Oncol.2015 Jun 3. [Epub ahead of print]
OBJECTIVE: The aim of this study was to compare the toxicity, perioperative outcomes of interval debulking surgery (IDS), and duration of progression-free survival (PFS) in women with unresectable high-grade serous advanced ovarian cancer (AOC) receiving neoadjuvant chemotherapy (NACT) with or witho
PMID 26036187

A rare presentation of complication arising from Meckel's diverticulum in the form of diverticulotransverse colonic fistula in an adult.

Lo T1, Sagar J2, Trickett J2.
BMJ case reports.BMJ Case Rep.2015 Jun 3;2015. pii: bcr2013203330. doi: 10.1136/bcr-2013-203330.
Meckel's diverticulum is a common congenital malformation of the gastrointestinal tract, reported to be present in 2-4% of the population. Although most patients with Meckel's diverticulum remain asymptomatic throughout life, reports of acute inflammation, perforation, haemorrhage, intussusception,
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Weber NK1, Fletcher JG, Fidler JL, Barlow JM, Pruthi S, Loftus EV Jr, Pardi DS, Smyrk TC, Becker BD, Pasha SF, Bruining DH.
Abdominal imaging.Abdom Imaging.2015 Jun;40(5):1060-7. doi: 10.1007/s00261-014-0144-7.
PURPOSE: Small bowel adenocarcinoma is uncommon in patients with Crohn's disease but has an extremely poor prognosis. There is a paucity of data on the clinical characteristics and radiologic features of this entity. We sought to update our institutional experience with small bowel adenocarcinoma oc
PMID 24760323

Japanese Journal

多発筋炎に対するステロイド治療中にサイトメガロウイルス腸炎による大腸穿孔を来した1例

日本消化器外科学会雑誌 49(1), 43-48, 2016
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肋間動脈瘤破裂を来した血管型Ehlers-Danlos症候群の1例

日本呼吸器外科学会雑誌 30(1), 80-86, 2016
NAID 130005119527

4. Crohn病腸管病変に対する外科治療(<特集>炎症性腸疾患外科治療の最近の動向)

日本外科学会雑誌 116(2), 94-98, 2015-03-01
NAID 110009919278

Related Pictures

★リンクテーブル★

リンク元	「腸穿孔」
関連記事	「perforation」「bow」

「腸穿孔」

Gastrointestinal perforation
	ruptured bowel, gastrointestinal rupture
	Free air under the right diaphragm from a bowel perforated.
Classification and external resources
Specialty	gastroenterology, emergency medicine
ICD-10	K63.1, S36.9
ICD-9-CM	569.83, 863.9
DiseasesDB	34042
MedlinePlus	000235
eMedicine	med/2822
	[edit on Wikidata]

　　[★]

英: intestinal perforation、bowel perforation
関: 腸管穿孔

「perforation」

　　[★]

n.

穿孔

関: bore、drill、perforate

「bow」

　　[★] 　　　　　　　　　　　　　　　

[Dom2013-1] Domino, Frank J.; Baldor, Robert A. (2013). The 5-Minute Clinical Consult 2014. Lippincott Williams & Wilkins. p. 1086. ISBN 9781451188509. Retrieved 4 August 2016.

[Lang2008-2] ^ ^a ^b ^c ^d ^e ^f ^g ^h ⁱ ^j ^k ^l ^m ⁿ ^o Langell, JT; Mulvihill, SJ (May 2008). "Gastrointestinal perforation and the acute abdomen.". The Medical clinics of North America. 92 (3): 599–625, viii–ix. PMID 18387378.

[3] Wong, PF; Gilliam, AD; Kumar, S; Shenfine, J; O'Dair, GN; Leaper, DJ (18 April 2005). "Antibiotic regimens for secondary peritonitis of gastrointestinal origin in adults.". The Cochrane database of systematic reviews (2): CD004539. PMID 15846719.

[4] Wilson, William C.; Grande, Christopher M.; Hoyt, David B. (2007). Trauma: Resuscitation, Perioperative Management, and Critical Care. CRC Press. p. 882. ISBN 9781420015263.

[5] Yeo, Charles J.; McFadden, David W.; Pemberton, John H.; Peters, Jeffrey H.; Matthews, Jeffrey B. (2012). Shackelford's Surgery of the Alimentary Tract (7 ed.). Elsevier Health Sciences. p. 701. ISBN 1455738077.

[6] Ansari, Parswa. "Acute Perforation". Merck Manuals. Retrieved June 30, 2016.

[7] Sharma AK, Sharma RK, Sharma SK, Sharma A, Soni D (2013). "Typhoid Intestinal Perforation: 24 Perforations in One Patient". Ann Med Health Sci Res. 3 (Suppl1): S41–S43. doi:10.4103/2141-9248.121220. PMC 3853607.

[8] R I Russell (2001). "Non-steroidal anti-inflammatory drugs and gastrointestinal damage—problems and solutions". Postgrad Med J. 77 (904): 82–88. doi:10.1136/pmj.77.904.82.

[9] Carlos Sostres; Carla J Gargallo; Angel Lanas (2013). "Nonsteroidal anti-inflammatory drugs and upper and lower gastrointestinal mucosal damage". Arthritis Res Ther. 15 (Suppl 3): S3. doi:10.1186/ar4175. PMC 3890944.

[10] Ramasamy, Kovil; Gumaste, Vivek V. (2003). "Corrosive Ingestion in Adults". Journal of Clinical Gastroenterology:. 37 (2): 119–124.

[11] Rustagi, T; McCarty, TR; Aslanian, HR (2015). "Endoscopic Treatment of Gastrointestinal Perforations, Leaks, and Fistulae.". Journal of clinical gastroenterology. 49 (10): 804–9. PMID 26325190.

v t e Nonmusculoskeletal injuries of abdomen and pelvis (S30–S39, 863–868)

Abdomen / GI	Ruptured spleen Blunt splenic trauma Traumatic diaphragmatic hernia Gastrointestinal perforation Liver injury Pancreatic injury

Pelvic	Uterine perforation Penile fracture

匿名

検索

案内

案内

bowel perforation