title: Perforation through small bowel malignant tumors.
abstract: Data on 19 patients (6 women and 13 men) with malignancy perforation through small bowel tissue were retrospectively reviewed. The median patient age was 57 years (range, 41-81 years). The histopathology included lymphoma (seven patients), leiomyosarcoma (two patients), gastrointestinal stromal tumor (one patient), adenocarcinoma (one patient), metastatic carcinomas with unknown primary tumor (four patients), metastatic adenocarcinoma from the lung (one patient), and metastatic carcinomas from the hypopharynx (one patient), cervix (one patient), and lung (one patient). Resection of a segment of perforated bowel with primary anastomosis was performed in 16 patients, wedge resection of perforated lesion with plication in two patients, and loop ileostomy in one patient. Postoperative deaths occurred in 10 (52.6%) patients, owing to sepsis and organ functional failure. Seven patients died from the primary malignancy at a median follow-up of 6.5 months (range, 5 months to 1 year 9 months) after surgery. Moreover, two patients with small bowel lymphoma were alive with disease at 4 years 8 months and 7 years 1 month after surgery. In conclusion, perforation through small bowel malignant tumors had a high postoperative mortality rate. High index of suspicion of the disease with early surgical treatment may improve treatment outcomes.
authors.affiliation: Division of General Surgery, Department of Surgery, Chang Gung University College of Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan. tcchai@adm.cgmh.org.tw
authors.forename: Tzu-Chieh
authors.initials: TC
authors.lastname: Chao
authors.forename: Hsiao-Hsiang
authors.initials: HH
authors.lastname: Chao
authors.forename: Yi-Yin
authors.initials: YY
authors.lastname: Jan
authors.forename: Miin-Fu
authors.initials: MF
authors.lastname: Chen
mesh_terms: D000328:Adult; D000368:Aged; D000714:Anastomosis, Surgical; D001707:Biopsy, Needle; D015331:Cohort Studies; D013505:Digestive System Surgical Procedures / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D007078:Ileal Neoplasms / Q000150:complications* / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D007150:Immunohistochemistry; D007416:Intestinal Perforation / Q000209:etiology* / Q000401:mortality / Q000473:pathology / Q000601:surgery; D007580:Jejunal Neoplasms / Q000150:complications* / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D007813:Laparotomy / Q000379:methods; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D009367:Neoplasm Staging; D011336:Probability; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D016019:Survival Analysis; D016896:Treatment Outcome