Non-traumatic ileal perforation: A retrospective study

Abstract

Objective:To determine clinical features, operative findings and post-operative complications in patients operated for non-traumatic ileal perforation and to discuss the role of typhoid vaccination.Materials and Methods:A retrospective study was carried out from 2009-2010. Seven patients were admitted through casualty as cases of acute abdomen. Underlying conditions were typhoid ulcers (4 patients) and non-specific etiology (3 patients). Diagnosis was made on clinical grounds, laboratory investigations, radiology and operative findings. Exploratory laporotomy was done. Different variables studied post-operatively were wound infection, residual abscess, recurrence and delayed post-operative complications.Results:Tenderness, distension and rigidity were found in maximum patients. Gases under diaphragm and air fluid levels were common radiological findings. However, widal test and blood culture for S. typhi was positive in four patients. Six patients had single perforation and one patient had two perforations, all being on antimesentric border of ileum. Maximum patients had peritoneal collection of less than 1000 ml. In five patients simple closure of perforation was done and in remaining two resection with end to side ileotransverse anatomosis was required. Wound infection and residual intraabdominal abscess were found in one patient each.Conclusion:Management criteria remain same in typhoid and non-specific perforations. Commonest cause of ileal perforation is typhoid fever in our country, so immunization against typhoid beyond 18 years of age is recommended.

A prospective study of epidemiology and clinical presentation of non-traumatic acute abdomen cases in a tertiary care hospital of central India

“…In a study done by Singh et al in 2014 concluded abdominal tenderness and abdominal distension as the commonest sign and study done by Hagos M et al conducted in 2015 concluded that abdominal tenderness is the commonest sign (96%) followed by abdominal guarding/rigidity (90%). 9,10 Hence, signs in our study have similar findings compared with the study done by other two authors.…”

A Descriptive Study of Surgical Management of Ileal Perforation

“…However, in moderate peritoneal contamination with multiple perforations very close to each other and perforation in close proximity to ileocaecal junction, resection with end to side ileotransverse anastomosis was resorted. 19 Previously, many authors have advocated use of an ileotransverse anastomosis in adverse situations to reduce stress on the primary closure suture line. But the authors feel a no suture line approach would be better.…”

“…18 According to Gurjit Singh et al degree of faecal contamination, general health status of patient, number and location of perforation were main deciding factors for selecting the type of surgical operations. 19 When there was minimum peritoneal contamination with single perforation quite far away from ileocaecal junction with good general health, simple closure of perforation in two layers after excision of edges should be advocated. However, in moderate peritoneal contamination with multiple perforations very close to each other and perforation in close proximity to ileocaecal junction, resection with end to side ileotransverse anastomosis was resorted.…”

Prospective Study of Patients Presenting With Small Bowel Perforations and Outcome in A Rural Hospital In South India

“…Population based studies from urban population in India suggest that incidence of typhoid fever is 2730 per 100,000 populations per year in 0-4 year old children, 1170 per 100,000 per year in 5-19 year age group and 110 per 100 000 per year in 20-40 year age group. 88 World-wide, typhoid fever undoubtedly represents the most common cause of small intestinal perforation. 15 Earlier, in two large series of patients with typhoid fever, perforation occurred in 78 of 1470 patients (5.3%), and 141 of 789 patients (17.9%).…”