Clinicopathological study of Ileal perforation: study in tertiary center

Abstract

INTRODUCTIONHollow viscus perforation leading to peritonitis is one of the commonest emergency surgeries conducted in a surgical practice for a case of acute abdomen.1 It is the second most common cause for acute abdomen following appendicitis. Perforation as a cause of acute abdomen accounts for 30-40% of the total cases of acute abdomen presenting to a surgical emergency.2 Among the cases of hollow viscus perforation duodenal and gastric perforations are the commonest accounting to almost 60-80 % in some series, followed by ileal, appendicular and large bowel. ABSTRACT Background:The objective of this study was to evaluate the clinicopathological characteristics in Ileal perforations because of confusion and controversy over the diagnosis and optimal surgical treatment of terminal Ileal perforationa cause of obscure peritonitis. Perforation of terminal ileum is a cause for obscure peritonitis with severe toxic state, there may be obscured clinical features with resultant delays in diagnosis and adequate surgical intervention. Methods: A prospective study was conducted in Victoria Hospital and Bowring and Lady Curzon Hospital attached to Bangalore Medical College and Research Institute over a period of 5 years from June 2011 to May 2015. A total of 136 patients presented in this period with hollow viscus perforation and out of these 64 patients had Ileal perforation alone on exploratory laparotomy. Ileal perforations account for about 20 percent of all cases of hollow viscus perforation. Emergency exploratory laparotomy was done and perforation was identified, edge biopsy was taken in all cases and the perforation was closed in two layers and resection anastomosis was done in stricture with perforation. Histopathological report was reviewed following surgery. Results: A total of 64 patients with Ileal perforation were included in the study of which 52 were males and 12 were females accounting for 81.25 percent and 18.75 percent respectively. The causes for perforation were enteric fever (82.81%), nonspecific inflammation (9.38%), and tuberculosis (7.81%). Simple closure of the perforation (74.58%) and the remaining primary resection and anastomosis were the mainstay of the surgical management. Conclusions: The common pathology of Ileal perforation is Typhoid or Enteric fever, Non-specific ulcer, Tuberculosis and others. Intestinal complications of typhoid fever are quite common in developing countries. Nonspecific inflammation of the terminal ileum was other predominant cause operative findings were similar to that of typhoid fever but no laboratory evidence of the disease was found. Intestinal tuberculosis can mimic many conditions.

A Comparative Study of Primary Repair Versus Resection and Anastomosis in Jejunoileal Perforations

“…In this study , ileo jejunal perforations are more in males with a ratio of 4:1 . The male to female ratio in studies like Poornima R et al and Shrivastava D et al were 4.33:1 and 6.38:1 respectively which was (7) similar to our results.…”

Complications and mortality of typhoid fever: A global systematic review and meta-analysis

“…Among surgical studies, misclassification of non-typhoid causes of intestinal perforation as TIP are increasingly recognized. 138 We were limited by the use of intra- and postoperative findings in classifying ileal perforations as TIP. We attempted to address this limitation by abstracting and presenting the criteria defining a case of TIP by study.…”

Terminal Ileum Perforation

“…Other causes include Crohn disease, irradiation, obstruction, nonspecific inflammation, embolic events, and tuberculosis. 7,10,11 Verocytotoxin-producing E. coli and PWS have not been reported to cause perforation at the terminal ileum. The decreased intestinal motility from PWS may have resulted in increased VTEC toxin exposure for a relatively prolonged period at the terminal ileum.…”

“…The most common reported cause is typhoid fever, making up more than 60% of cases. Other causes include Crohn disease, irradiation, obstruction, nonspecific inflammation, embolic events, and tuberculosis 7,10,11 . Verocytotoxin-producing E. coli and PWS have not been reported to cause perforation at the terminal ileum.…”