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HomeMedical StudyENDOSCOPIC SECTION๐—ฆ๐˜๐—ฎ๐—ฝ๐—ณ๐—ฒ๐—ฟ ๐—ฐ๐—น๐—ฎ๐˜€๐˜€๐—ณ๐—ถ๐—ฐ๐—ฎ๐˜๐—ถ๐—ผ๐—ป ๐—ผ๐—ณ ๐—˜๐—ฅ๐—–๐—ฃ ๐—ถ๐—ป๐—ท๐˜‚๐—ฟ๐˜† ๐—ผ๐—ณ ๐—ฑ๐˜‚๐—ผ๐—ฑ๐—ฒ๐—ป๐˜‚๐—บ/๐—–๐—•๐——/๐—”๐—บ๐˜‚๐—ฝ๐—น๐—น๐—ฎ:

๐—ฆ๐˜๐—ฎ๐—ฝ๐—ณ๐—ฒ๐—ฟ ๐—ฐ๐—น๐—ฎ๐˜€๐˜€๐—ณ๐—ถ๐—ฐ๐—ฎ๐˜๐—ถ๐—ผ๐—ป ๐—ผ๐—ณ ๐—˜๐—ฅ๐—–๐—ฃ ๐—ถ๐—ป๐—ท๐˜‚๐—ฟ๐˜† ๐—ผ๐—ณ ๐—ฑ๐˜‚๐—ผ๐—ฑ๐—ฒ๐—ป๐˜‚๐—บ/๐—–๐—•๐——/๐—”๐—บ๐˜‚๐—ฝ๐—น๐—น๐—ฎ:

Stapfer type ๐—œ are free bowel wall perforations, usually from the endoscope, and these tend to be larger and require immediate operative repair.
โ€ขType ๐—œ๐—œ are retroperitoneal duodenal perforations and are secondary to periampullary injury. These are the most commonly encountered type of perforation and require surgical intervention depending on severity.
โ€ขType ๐—œ๐—œ๐—œ perforations involve the pancreatic or distal common bile duct and are usually secondary to wire, basket, or balloon instrumentation.
โ€ขType ๐—œ๐—ฉ perforations occur when only retroperitoneal air is seen and may not represent true perforation. Some authors suggest that in the absence of physical exam findings, retroperitoneal air can be a result of insufflation used to maintain lumenpatency during endoscopic procedures.
๐—ฆ๐˜๐—ฎ๐—ฝ๐—ณ๐—ฒ๐—ฟ ๐—ฐ๐—น๐—ฎ๐˜€๐˜€๐—ณ๐—ถ๐—ฐ๐—ฎ๐˜๐—ถ๐—ผ๐—ป ๐—ผ๐—ณ ๐—˜๐—ฅ๐—–๐—ฃ ๐—ถ๐—ป๐—ท๐˜‚๐—ฟ๐˜† ๐—ผ๐—ณ ๐—ฑ๐˜‚๐—ผ๐—ฑ๐—ฒ๐—ป๐˜‚๐—บ/๐—–๐—•๐——/๐—”๐—บ๐˜‚๐—ฝ๐—น๐—น๐—ฎ:
๐— ๐—ฎ๐—ป๐—ฎ๐—ด๐—ฒ๐—บ๐—ฒ๐—ป๐˜:
โ€ข๐— ๐—ฒ๐—ฑ๐—ถ๐—ฐ๐—ฎ๐—น management can be attempted in patients with retroperitoneal perforations who are
hemodynamically stable and who exhibit no evidence of peritonitis. ๐—ฆ๐˜‚๐—ฟ๐—ด๐—ฒ๐—ฟ๐˜† should be reserved for patients with hemodynamic instability, exam findings consistent with peritonitis, a large free perforation, and a biliary obstruction or for those who do not improve after a trial of non-operative management.

๐—ฅ๐—ฒ๐—ณ: Emergency General Surgery, springer, 2020

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