Less Common Nontraumatic Bowel Perforations: Diagnosis and Management through a Retrospective Study

Abstract

Nontraumatic bowel perforation has always been a consideration because of associated morbidity and mortality. The aim of this study is to define etiologies, treatment, and outcomes as well as to highlight difficulties in the diagnosis and management of nontraumatic bowel perforation. We conducted a retrospective study of 35 patients with less common nontraumatic bowel perforations hospitalized during a six-year period. The most common cause was ulcerative colitis (34.3%). Abdominal pain was the constant symptom. Physical examination showed signs of peritoneal irritation in 29 cases. The abdominal radiograph failed to reveal abnormal findings in two patients; the abdominal computed tomography scan confirmed the diagnosis in all cases. Twenty patients (57.1%) were operated on within 24 hours of developing perforation, whereas seven patients (20%) were initially misdiagnosed. Most of the perforations were located only in the large intestine (60%). There was only one perforation in 25 patients (71.5%) and two or more perforations in 10 patients (28.5%). Many less common diseases are responsible for the spontaneous perforation of the bowel. Early diagnosis before the patient's general condition deteriorates decreases mortality and morbidity rates. Adequate resuscitation and emergency laparotomy followed by resection with or without anastomosis remains the treatment of choice.

Totally Laparoscopic Repair of an Ileal and Uterine Iatrogenic Perforation Secondary to Endometrial Curettage

“…Early diagnosis before patients' conditions deteriorate, will decrease mortality and morbidity rates. 16 Small bowel perforation is associated with fewer complications when it is treated earlier than 24 h after injury. Delay in surgical treatment beyond this deadline will not significantly increase the mortality, although the complication rate will be dramatically higher.…”

Colon Perforation and Budd-Chiari Syndrome in Behçet’s Disease

“…Among the other histomorphological findings of BD, near-normal mucosa is observed in regions away from the lesions, and lymphoid aggregates or granulomas are not found [ 8 , 15 ]. In general, mortality of colonic perforation ranges from 35% to 47% [ 19 ]. Kasahara et al [ 17 ] reported that postoperative ulcer recurrence within 6 months occurred in 22 of 34 patients (65%), whereas recurrence did not occur in 5 patients after more than 3 years of treatment.…”

Abdominal trauma leading to diagnosis of Crohn’s disease

“…Crohn’s disease has been reported in the literature to present with symptoms similar to ruptured appendicitis [1] , military tuberculosis [2] , and even condylomata acuminata [3] . Crohn’s disease is primarily diagnosed in children in the context of nontraumatic bowel perforations [4] . Very rarely is it first diagnosed in the context of trauma.…”