Correlation of gastrointestinal perforation location and amount of free air and ascites on CT imaging

Prediction of injury localization in preoperative patients with gastrointestinal perforation: a multiomics model analysis

BACKGROUND

The location of gastrointestinal perforation is essential for severity evaluation and optimizing the treatment approach. We aimed to retrospectively analyze the clinical characteristics, laboratory parameters, and imaging features of patients with gastrointestinal perforation and construct a predictive model to distinguish the location of upper and lower gastrointestinal perforation.

METHODS

A total of 367 patients with gastrointestinal perforation admitted to the department of emergency surgery in Fujian Medical University Union Hospital between March 2014 and December 2020 were collected. Patients were randomly divided into training set and test set in a ratio of 7:3 to establish and verify the prediction model by logistic regression. The receiver operating characteristic curve, calibration map, and clinical decision curve were used to evaluate the discrimination, calibration, and clinical applicability of the prediction model, respectively. The multiomics model was validated by stratification analysis in the prediction of severity and prognosis of patients with gastrointestinal perforation.

RESULTS

The following variables were identified as independent predictors in lower gastrointestinal perforation: monocyte absolute value, mean platelet volume, albumin, fibrinogen, pain duration, rebound tenderness, free air in peritoneal cavity by univariate logistic regression analysis and stepwise regression analysis. The area under the receiver operating characteristic curve of the prediction model was 0.886 (95% confidence interval, 0.840-0.933). The calibration curve shows that the prediction accuracy and the calibration ability of the prediction model are effective. Meanwhile, the decision curve results show that the net benefits of the training and test sets are greater than those of the two extreme models as the threshold probability is 20-100%. The multiomics model score can be calculated via nomogram. The higher the stratification of risk score array, the higher the number of transferred patients who were admitted to the intensive care unit (P < 0.001).

CONCLUSION

The developed multiomics model including monocyte absolute value, mean platelet volume, albumin, fibrinogen, pain duration, rebound tenderness, and free air in the peritoneal cavity has good discrimination and calibration. This model can assist surgeons in distinguishing between upper and lower gastrointestinal perforation and to assess the severity of the condition.

The role of immature granulocyte in the early prediction of gastrointestinal tract perforations

Background/Aim: Gastrointestinal system (GIS) perforations cause acute abdomen an indication for emergency intervention. Early detection is very important in gastrointestinal perforations to prevent mortality and morbidity. This study aimed to examine whether immature granulocyte (IG) and IG percentages (IG%) can be used as a simple and easy marker for identifying gastrointestinal system perforations early on. Methods: Between January 1, 2020, and January 1, 2022, 120 patients who presented to Hitit University Erol Olçok Training and Research Hospital's emergency service and underwent surgery on by the General Surgery Clinic with the diagnosis of the acute abdomen were investigated. The patients were divided into two groups. Patients in group 1 included those with peptic ulcers and bowel perforations. Group 2 was considered the control group. Of the 36 patients in group 2, 22 had acute appendicitis, 12 had ileus-related bridectomy or bowel resection, and two had acute cholecystitis. The common patient feature in this group was full-thickness or serosal iatrogenic bowel injury and repair. Pre-operative IG and IG% values were obtained from routine complete blood count values. IG and IG% values were compared between groups 1 and 2, and the predictive value of these biomarkers in the early diagnosis of GIS perforations was investigated. Results: The mean age of the patients was 55.49 (19.58). The study consisted of 45 (37.5%) female patients and 75 (62.5%) male patients. Group 1 had 84 patients, whereas Group 2 had 36. When the two groups were evaluated, the IG value was higher in Group 1 (P < 0.001). In terms of the percentage value of immature granulocytes, a statistically significant difference was found between Groups 1 and 2 (P = 0.001). As a result, Group 1's IG and IG% values were much greater than those in Group 2. Conclusion: IG and IG% values are inflammatory parameters that can be easily studied in routine hematology tests. According to this study, IG and IG% values were found to be higher in gastrointestinal tract perforations based on result blood tests taken at the time of admission to the emergency department.

Diagnostic error rates and associated factors for lower gastrointestinal perforation

Lower gastrointestinal perforation is rare and challenging to diagnose in patients presenting with an acute abdomen. However, no study has examined the frequency and associated factors of diagnostic errors related to lower gastrointestinal perforation. This large-scale multicenter retrospective study investigated the frequency of diagnostic errors and identified the associated factors. Factors at the level of the patient, symptoms, situation, and physician were included in the analysis. Data were collected from nine institutions, between January 1, 2015 and December 31, 2019. Timely diagnosis was defined as diagnosis at the first visit in computed tomography (CT)-capable facilities or referral to an appropriate medical institution immediately following the first visit to a non-CT-capable facility. Cases not meeting this definition were defined as diagnostic errors that resulted in delayed diagnosis. Of the 439 cases of lower gastrointestinal perforation identified, delayed diagnosis occurred in 138 cases (31.4%). Multivariate logistic regression analysis revealed a significant association between examination by a non-generalist and delayed diagnosis. Other factors showing a tendency with delayed diagnosis included presence of fever, absence of abdominal tenderness, and unavailability of urgent radiology reports. Initial misdiagnoses were mainly gastroenteritis, constipation, and small bowel obstruction. In conclusion, diagnostic errors occurred in about one-third of patients with a lower gastrointestinal perforation.