Insight into the management of non-traumatic perforation of the small intestine

Abstract

Introduction: Management of non-traumatic perforation of the small intestine has always been a consideration for surgeons because of associated enormous morbidity and mortality. There is a paucity of data on the management of non-traumatic perforation of the small intestine. Methodology: A retrospective study was conducted which involved analysis of 192 patients treated for non-traumatic perforation of small intestine in a tertiary care teaching hospital in North India. The clinical profile and management of the patients were studied. Results: The most common cause of non-traumatic perforation of small intestine was typhoid (46.4%), followed by non-specific inflammation (39.2%), tuberculosis (12.8%) and malignant neoplasm (1.6%). Primary repair was the most frequent procedure (44.0%), followed by ileostomy (25.5%) and resection-anastomosis (19.3%). Superficial wound infection was the most frequent postoperative complication (46.8%), followed by wound dehiscence (31.3%). The wound infection rate was reduced significantly following delayed primary closure of skin incision. Enterocutaneous fistula/leak developed in 11.5% patients. Salvage ileostomy for post-operative intestinal leak resulted in a better survival rate as compared to conservative treatment (85.7% vs. 50.0%). The overall mortality rate was 16.6%. Conclusion: Operative procedures undertaken for the management of non-traumatic perforation of small intestine can be classified into two groups: procedures that leave an intestinal suture line inside the peritoneal cavity and procedures that do not. The no suture line-in procedure seems to be better option in adverse patient conditions.

Quality of Life of Patients After Temporary Ileostomy for Ileal Perforation- A Questionnaire Based Study

“…These indications are unlike the developed world where most ileostomies are carried out to protect the rectal anastamosis after cancer surgery. Poor nutritional status, delayed presentation, presence of purulent peritonitis, and sepsis are few factors that make primary repair of perforation unsafe in patients of ileal perforation with peritonitis [1,2,5]. Typhoid and tuberculosis that remain public health problems in our country emerged as the main cause for ileal perforation in our study ( Table 1) similar to that reported in other studies [1,2,5].…”

“…In India and many other countries from Southeast Asia region, ileal perforation as a complication of conditions such as enteric fever, abdominal tuberculosis, and penetrating abdominal trauma constitutes the main indication for an emergent laparotomy that usually culminates into a temporary ileostomy [1,2,5]. These indications are unlike the developed world where most ileostomies are carried out to protect the rectal anastamosis after cancer surgery.…”

“…Poor nutritional status, delayed presentation, presence of purulent peritonitis, and sepsis are few factors that make primary repair of perforation unsafe in patients of ileal perforation with peritonitis [1,2,5]. Typhoid and tuberculosis that remain public health problems in our country emerged as the main cause for ileal perforation in our study ( Table 1) similar to that reported in other studies [1,2,5]. The conditions leading to ileal perforation were seen more in patients aged between 16 and 45 years (90 %, n036), thus affecting the socially productive age groups.…”

The surgical anatomy and etiology of gastrointestinal fistulas

“…Intestinal fistula formation due to infection is more frequent in developing countries [19]. The most common cause of non-traumatic perforation of the small intestine is typhoid (46.4%), followed by non-specific inflammation (39.2%), tuberculosis (12.8%), and malignant neoplasm (1.6%) [20]. Other The surgical anatomy and etiology of gastrointestinal fistulas possible causes are salmonella, amebiasis, actinomycosis, coccidioidomycosis, cryptosporidiosis, HIV, and possibly hookworms [19,20].…”

Should routine contrast study be a norm before stoma reversal? A retrospective study of patients with temporary ileostomy

“…1,2 At our institute, peritonitis due to ileal perforation is a common indication for emergency laparotomy that culminates into a temporary ileostomy as it is thought to be the safest option for many of these patients. [3][4][5] Also, it is customary to perform a contrast study of the distal bowel before stoma reversal. The time involved in obtaining a contrast study adds substantially to the overall waiting time before a stoma can be reversed.…”