Authors
Singaevsky A.B.1, 2, Azeyan A.A.3, Nesvit E.M.4, Akimova A.B.5, Fionik O.V.1, Gladyshev D.V.6
1 Almazov National Medical Research Centre, Saint Petersburg
2 Saint Petersburg City Hospital № 15, Saint Petersburg
3 Toksovskaya Medical Hospital, Leningrad Oblast
4 Saint Petersburg Clinical Hospital of Saint Luke, Saint Petersburg
5 I.I. Mechnikov North-Western State Medical University, Saint Petersburg
6 Saint Petersburg City Hospital № 40 of the Kurortny District, Saint Petersburg
Abstract
Background. Acute postoperative perforating ulcers of the small intestine (APPSUI) are an understudied but dangerous complication of abdominal and pelvic surgeries. The absence of national clinical guidelines for APPSUI management makes it difficult to choose the optimal surgical approach and postoperative patient management in case of this complication.
Aim. To determine the optimal surgical approach for managing APPSUI following abdominal and pelvic surgeries.
Methods. Analysis of medical records of patients who underwent emergency and elective surgeries on abdominal and pelvic organs at the I.I. Mechnikov North-Western State Medical University, City Hospital No. 40, and Toksovo Clinical Interdistrict Hospital between 2012 and 2025, followed by the development of APPSUI.
Inclusion criteria:
1. Age over 18 years;
2. History of surgery on abdominal or pelvic organs;
3. Development of acute perforating ulcers of the small intestine during the postoperative period within the current hospitalization.
Exclusion criteria:
1. Age under 18 years;
2. Development of small intestine perforation in close proximity to anastomoses or intestinal stomas (0.5-1 cm);
3. Inability to exclude small intestine perforation due to mechanical or thermal injury;
4. Generalized oncological process.
Results. The study analyzed medical records of 98 patients with diagnosed APPSUI. The age range of the study sample was 28 to 88 years (mean 55.5±14.1). Gender distribution: female (n = 62; 63.3%) of the total number of patients. Analysis of hospitalization type: 76.5% of patients (n = 75) were admitted to the hospital as emergencies.
The main finding: upon initial detection of APPSUI, suturing should be applied as it shows the lowest mortality rate (25%; p = 0.045). Resection of the affected area is recommended for repeated perforation and/or failure of previously sutured defect.
Conclusion. Differences in mortality rates depending on the chosen surgical approach for APPSUI were identified. The lowest mortality rate is observed with the suturing method, while the highest rate is characteristic of ileostomy formation when used at initial APPSUI detection.
In 29 (29.5%) patients, the first relaparotomy was scheduled, of which 13 (13.2%) had a favorable outcome. In other cases, relaparotomy was performed on demand (n=69 (70.4%)), of which 8 (11.5%) were discharged. The statistically significant difference (p < 0.001) between the groups confirms lower mortality in the scheduled relaparotomy group.
Keywords: аcute postoperative perforating ulcers of the small intestine, surgical approach, small intestine perforation, peritonitis, abdominal and pelvic surgeries, relaparotomy, small intestine suturing, small intestine resection.
References
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