reperforation

Reperforation is the recurrence or reopening of a perforation in a hollow organ after it has been closed or repaired. It is a potential complication across several medical fields, including gastrointestinal surgery, ENT (for example, tympanic membrane reperforation after repair), urology, and other visceral surgeries. Reperforation can present soon after the initial procedure or weeks to months later and may be associated with infection, tissue weakness, or ongoing disease processes.

Causes and risk factors include breakdown of the initial repair due to infection or inflammation, excessive tension on sutures, poor tissue quality, malnutrition or diabetes, immunosuppression, and radiation exposure. In some cases, mechanical erosion by implanted devices or stents can contribute. Reperforation may lead to leakage of luminal contents, contamination, sepsis, fistula formation, or organ dysfunction depending on the site.

Diagnosis relies on clinical suspicion and imaging. Signs may include new pain, fever, signs of peritonitis, leakage at the repair site, or reduced organ function. Diagnostic tools can include contrast studies, CT scanning, ultrasound, and, where relevant, endoscopy or otoscopy for nasal or tympanic organ involvement.

Management typically requires prompt surgical or procedural intervention to achieve source control, repair or resection of the damaged area, and restoration of continuity when feasible. Antibiotics and supportive care are essential, and temporary diversion (such as a stoma) or drainage may be employed. Prevention focuses on meticulous surgical technique, infection control, tension-free closures, appropriate tissue coverage, and addressing patient-related risk factors such as nutrition and comorbidities.

Prognosis varies with location and underlying conditions, but reperforation generally carries significant morbidity and requires urgent management.