Assessment of Predictors of Mortality and Severity in Patients with Colorectal Perforation

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Colorectal perforation is a life-threatening disease with high mortality and morbidity. The correct and prompt diagnosis and accurate judgment of severity are necessary. We retrospectively investigated 30 patients with colorectal perforation to assess predictors of mortality and severity, and evaluated the usefulness of computed tomography (CT) for the initial diagnosis. The severity of peritonitis was assessed using clinical factors and Physiological and Operative Severity Score for the enUmeration of Mortality and morbidity (POSSUM) scores. Abdominal free air was detected by CT in 92% of patients with colorectal perforation, whereas only 36.6% showed evidence of abdominal free air by conventional radiography. The perforation site was correctly diagnosed in 14 of 25 cases (56%). Overall mortality was 16. 7%. Survivors were younger than nonsurvivors, and POSSUM physiological and mortality scores were significantly lower for survivors compared with nonsurvivors. The amount of intraperitoneal soiling by large bowel content determined disease severity in terms of the need for postoperative respiratory management. In conclusion, CT is necessary for precise diagnosis, and the POSSUM score is helpful for the evaluation of disease mortality and severity.大腸穿孔症例は未だに死亡率が非常に高く, 正確で迅速な診断および重症度判定が必要とされる. 我々は, レトロスペクティブに30例の大腸穿孔症例を解析し, 初期診断におけるCTの有用性, また死亡率及び重症度予測因子についての検討を行った. 腹膜炎の重症度については, 臨床上の諸因子およびPOSSUMスコアを用いて評価した. 腹腔内遊離ガスの同定は, 単純X線検査では36.7%のみであったのに対して, CTでは92%で同定可能であった. さらに穿孔部位の同定もCT上25例中14例（56%）で可能であった. 本研究における大腸穿孔に対する手術症例の死亡率は16.7%であった. 生存例は死亡例と比較し, 年齢が若く, POSSUMスコア（Physiological score, Mortality）が有意に低かった. 腹腔内汚染腹水の程度は, 術後呼吸器管理の必要性を指標とした重症度と関連していた. 大腸穿孔の診断にはCTが優れており, POSSUMスコアは死亡率および重症度の評価に有用であった.
2011-03-25

Assessment of Predictors of Mortality and Severity in Patients with Colorectal Perforation

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