Preoperative Evaluation And Prognostic Case Analysis Of Spontaneous Colonic Perforation

Background:Perforation of the colon is one of the common reasons for emergency surgery with a lot of complications. While the nursing and surgical techniques have made significant progress, but the surgical outcomes of perforation are still poor with a high morbidity and mortality. Prior studies have shown that the severity of peritonitis and malignancy are two important factors which affecting prognosis. And other prognostic factors, including age, organ failure and so on, can be evaluate by Mannheim peritonitis index,(MPI), physiological and operative severity scoring system (P-POSSUM), Sepsis-related organ failure,(SOFA), Acute Physiology and Chronic Health Evaluation (APACHEII), and Multiple Organ Failure (MOF). These scores also are used in order to have a better assessment of the prognostic factors.Recent literature and reports were mainly based on surveys in Western populations, and less analysis for our spontaneous colonic perforation. The incidence of colon cancer and inflammatory bowel disease in the West are different from our country,and also the diverticulitis have different rates. So the assess of spontaneous colonic perforation has its significance. Assessing risk prediction score for each evaluation method has its value for seeking effective treatment. Materials and methods:A retrospective analysis of19patients who treated of spontaneous colonic perforation in Run Run Shaw Hospital, Zhejiang University School of Medicine,from2006.1to2013.12.The patients are excluded for traumatic and iatrogenic perforation, such as colonoscopy or polypectomy, etc. This study uses multiple systems MPI, P-POSSUM, SOFA and MOF to evaluate patients’ condition before the surgery and the postoperative complications.The analysis is used by IBM SPSS Statistics19software,using T test, ANOVA, Spearman correlation cohort analysis.Results:Patients’ mean age is65, inflammatory perforation rate is57.9%, tumorous perforations are occurred in Ⅲ-Ⅳ stage patients (85.7%), tumor perforation positions were located at the proximal place (2-5cm). The correlation coefficient of MPI and SOFA is0.766(p=0.001), correlation coefficient with the MOF is0.476(p=0.039). The correlation coefficient of P-POSSUM and SOFA is0.814(p=0.001), but no significant correlation between MOF (p>0.05). The severity of the patients who experienced tumorous perforation is greater than non-tumorous perforation (MPI:25.9vs.10.4, p=0.001; P-POSSUM:.35.0vs.28.0, p=0.001), and the organ failure may occur more often(tumor vs non-tumor, SOFA:.6.86vs.1.17, p=0.002). The respiratory complications and renal complications are more often for tumorous patients than non-tumorous patients (p=0.002; p=0.003). Surgical group of the cancer patients mostly had radical surgery and colostomy, the actual mortality rate is0.00%within one month after the surgery,compared with the predicted mortality is4.40%.Conclusion:Spontaneous colonic perforations are mainly in elderly patients, with inflammatory perforation for about2/3.And the tumorous perforation occurred in Ⅲ- IV stage patients. The perforation positions were located near the tumors rather than the place of the tumor itself. The MPI and P-POSSUM scores were strongly correlated with the SOFA score, which can produce better predict postoperative complications.But the P-POSSUM score is better, but more time-consuming to assess. MPI score is simple, more suitable for surgery assessment. The severity of the tumorous perforation is larger than the non-tumorous perforation.While the patients with tumors had the higher probability for postoperative respiratory complications and renal complications than the non-tumorous patients. Surgical group of the cancer patients mostly had radical surgery and colostomy, making the actual mortality rate lower than the forecast mortality.