Journal Title: تابستان 86
Article title: Assessment of Gastrointesinal Perforation in Dr. Shariati Hospital from 2002 to 2007

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Article abstract:
Introduction & Objective: Gastrointestinal perforation is one of the most important causes of emergent surgeries in surgery wards. On the other hand, mortality is high in this group because of underlying diseases and delay in diagnosis. Assessment of these patients is helpful especially in a tertiary care center. Materials & Methods: In a five-year period from 2002 to 2007, we reviewed clinical records of patients with gastrointestinal perforations from esophagus to rectum (excluding perforated appendicitis). Demographic data, underlying diseases, location, and causes of perforation and outcome of patients extracted and analyzed. Results: From 80 patients, 60 (75%) were male and 20 (25%) were female. Mean age was 51+19 years old. The most common causes of perforation were peptic ulcers (36%), trauma (17%), malignancy (15%), and iatrogenic due to endoscopic procedures (12.5%). In peptic ulcer subgroup, mean age was 52.6 year. Twenty two patients (81.5%) were male and five (18.5%) were female. There was no statistical difference in admission month and season in this subgroup. Site of perforation was stomach in 19 (65.5%) and duodenum in 10 (34.5%). Seven patient (24%) with perforated peptic ulcer expired. Mortality was not related with history of gastrointestinal disease, smoking, alcohol consumption, opium addiction, NSAID or corticosteroid use, and ischemic heart disease. There was no association between mortality and leukocyte count, perforation size, and time from symptoms to surgery; but mortality was significantly associated to underlying disease (P-Value = 0.041) and patients with underlying disease were older than others (P<0.005). Conclusions: The most common cause of gastrointestinal perforation (excluding perforated appendicitis) is peptic ulcer disease, which is more common in males. The most related factors with mortality was the presence of underlying disorders which are more in the older. This shows importance of proper diagnosis in geriatric patients. In centers with frequent diagnostic and therapeutic endoscopic procedures, iatrogenic gastrointestinal perforation is among common causes of perforation.
Article KeyWords:
Gastrointestinal, Perforation, Peptic Disease
Article Authors:

	دكتر احمدرضا سروش	First Author
	دكتر ژامک خورگامی	Other Author	khorgami@tums.ac.ir
	دکتر محمدرضا حکیمیـان	Other Author
	دکتر ندا احتشامی	Other Author
	دکتر مطهـره آقاجانی	Other Author