exudates and Intestinal-Perforation

To compare the outcomes and costs of endoluminal clipping and surgery in the management of iatrogenic colonic perforation.. A retrospective, single-center, clinical and economic analysis of outcomes and costings between endoluminal clipping and surgery in consecutive cases of iatrogenic colonic perforations was conducted.. In total, 7136 colonoscopies performed over a 6-year period were complicated by 12 (0.17%) perforations. Seven cases were treated by endoscopic clipping (with a success rate of 71.4%) and five with immediate surgery. Both groups of patients had similar clinical and individual characteristics. Patients who were treated with endoscopic clipping had a shorter period of hospitalization (median 9 vs 13 days) compared to surgery, but this was not statistically significant. Compared to patients who had immediate surgery, the median direct health-care costs for all procedures (US$ 115.10 vs US$ 1479.50, P = 0.012) and investigations (US$ 124.60 vs US$ 512.90, P = 0.048) during inpatient stay were lower for the endoscopic clipping group. There was a trend towards a lower overall inpatient median cost for patients managed with endoscopic clipping compared to surgery (US$ 1481.70 vs US$ 3281.90, P = 0.073).. Endoluminal clipping may be more cost-effective than surgery in the management of iatrogenic colonic perforations.

Topics: Aged; Colon; Colonoscopy; Cost-Benefit Analysis; Female; Health Care Costs; Health Resources; Humans; Iatrogenic Disease; Intestinal Perforation; Malaysia; Male; Middle Aged; Retrospective Studies; Suture Techniques; Treatment Outcome

A 1 year review of 529 cases of acute appendicitis, treated at the University Hospital in 1990, was performed. Perforation rate was 23.7% and delay in diagnosis was found to be significant. Patients above 50 years of age were particularly at risk. Diagnostic error was 19.3% and it was a problem not only in young women but also in children. Temperature and rectal examinations were not found to be helpful in the diagnosis in contrast to leukocytosis. Waiting time for operation was long (median 7 hours), be it for a perforated or a nonperforated appendicitis.

Topics: Acute Disease; Adult; Aged; Appendicitis; Body Temperature; Child; Child, Preschool; Diagnostic Errors; Hospitals, University; Humans; Intestinal Perforation; Malaysia; Middle Aged; Physical Examination; Rectum; Risk Factors; Rupture, Spontaneous; Time Factors

Topics: Aged; Colon, Sigmoid; Female; Humans; Intestinal Perforation; Malaysia; Male; Massage; Medicine, Traditional; Middle Aged