Journal of Clinical Oncology, Vol 6, 291-296, Copyright © 1988 by American Society of Clinical Oncology
Emergency laparotomy for spontaneous intestinal and colonic perforations in cancer patients receiving corticosteroids and chemotherapy
MH Torosian and AD Turnbull
Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York.
Thirty patients with lymphoma (12), leukemia (two), myeloma (one), or
metastatic solid tumors (15) were explored for 31 episodes of spontaneous
intestinal perforation during an 11-year period at Memorial Sloan-Kettering
Cancer Center. Twenty-three patients (76.6%) were receiving corticosteroids
alone or in combination with chemotherapy and seven patients (23.4%) were
receiving chemotherapy alone at the time of perforation. Fourteen
perforations (45%) occurred in the small intestine and 17 perforations
(55%) occurred in the colon. Malignancy was histologically demonstrated at
the site of perforation in 16 patients (52%). Twenty major postoperative
complications occurred in 15 patients (50%) and the operative mortality
rate was 53%. Factors such as age, sex, duration or type of symptoms, site
of perforation, malignancy at the site of perforation, peripheral leukocyte
count, and serum albumin and total protein levels were not significantly
related to patient survival. Early diagnosis and aggressive surgical
intervention is essential to improve survival following intestinal
perforation in this high-risk population.
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