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

  • Bhupendra Kumar Jain Department of Surgery, University College of Medical Sciences & GTB Hospital, University of Delhi, New Delhi
  • Himanshu Arora Department of Surgery, University College of Medical Sciences & GTB Hospital, University of Delhi, New Delhi
  • Upendra Kumar Srivastava Department of Surgery, University College of Medical Sciences & GTB Hospital, University of Delhi, New Delhi
  • Debajyoti Mohanty Department of Surgery, University College of Medical Sciences & GTB Hospital, University of Delhi, New Delhi
  • Pankaj Kumar Garg Department of Surgery, University College of Medical Sciences & GTB Hospital, University of Delhi, New Delhi
Keywords: Perforation peritonitis, operative strategies, complications

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.

Published
2010-10-15
How to Cite
1.
Jain BK, Arora H, Srivastava UK, Mohanty D, Garg PK (2010) Insight into the management of non-traumatic perforation of the small intestine. J Infect Dev Ctries 4:650-654. doi: 10.3855/jidc.829
Section
Original Articles