title: Assessment of predictors of mortality and severity in patients with colorectal perforation.
abstract: 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.
authors.affiliation: Department of Surgery, Fukuoka-Higashi Medical Center, Fukuoka, Japan. akinori@surg2.med.kyushu-u.ac.jp
authors.forename: Akinori
authors.initials: A
authors.lastname: Egashira
authors.forename: Tomohiro
authors.initials: T
authors.lastname: Iguchi
authors.forename: Tadahiro
authors.initials: T
authors.lastname: Nozoe
authors.forename: Eisuke
authors.initials: E
authors.lastname: Adachi
authors.forename: Akito
authors.initials: A
authors.lastname: Matsukuma
authors.forename: Takahiro
authors.initials: T
authors.lastname: Ezaki
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Kakeji
authors.forename: Shunichi
authors.initials: S
authors.lastname: Tsujitani
authors.forename: Yoshihiko
authors.initials: Y
authors.lastname: Maehara
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003108:Colonic Diseases / Q000175:diagnosis / Q000401:mortality*; D005260:Female; D006801:Humans; D007416:Intestinal Perforation / Q000175:diagnosis / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012002:Rectal Diseases / Q000175:diagnosis / Q000401:mortality*; D012189:Retrospective Studies; D012720:Severity of Illness Index; D014057:Tomography, X-Ray Computed