Giant peptic perforation is a life threatening surgical emergency with high mortality.. This study aims to compare the success rate between omental plugging and standard omentopexy in the emergency management of giant perforations. A prospective non-randomized study of 23 patients with giant peptic perforation (≥2 cm in diameter) was carried out over a period of 18 months. The highest incidence was seen in the age group of 41-50 years. Intestinal fistula occurred in 23.08% of the omentopexy group compared to none in the omental plugging group. The mean hospital stay was slightly higher in the omentopexy group. Three patients died in the omentopexy group post operatively after 24 h compared to none in the omental plugging group and this was statistically significant (p<0.05). Omental plugging is associated with lesser morbidity and mortality compared to omentopexy in the management of giant peptic perforations.

Crohn's Disease is a chronic, idiopathic, transmural inflammatory disease affecting predominantly distal ileum, the common presentation include stricture and fistula formation. Free perforation in the peritoneal cavity is rare. To study the presentation and management of Crohn's perforation. A retrospective study of 9 cases of perforative peritonitis later diagnosed due to Crohn's disease on histopathological examination. Among the 9 patients, 8 were males and 1 was female. The ages of the patients ranged from 30 to 58 years, with mean age of 41.8 years. 6 patients were in the age group of 30-45 years. 8 patients were not known to be suffering from Crohn's. Resection followed by anastomosis was done in 4 cases including the case of known Crohn's, while resection follwed by end illeostomy with mucous fistula was done in remaining cases. Resected specimens were sent for histopathological examination in all cases. Though Crohn's perforation is rare it should be kept in mind when dealing with single or multiple perforation of the small intestine even in the developing countries. Though the number of cases in our series are too few to come to a conclusion, we found that illeostomy sems a prudent alternative to traditional resection anastomosis.