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

Abstract

Introduction: The wide spectrum of etiologies resulting in small intestinal perforation with nonspecific clinical picture poses a challenge for the diagnosis to the general surgeon. The delayed diagnosis thereby delays the management leading to high morbidity and mortality. This study was an attempt to find out the common causes of small bowel perforation and outcome. The prevalence of small bowel perforation in the selected population remains unknown. Hence considering the frequency of small bowel perforation the sample size was estimated based on formula Sample size (n) = 4 p q /d 2 Aims & Objectives: To study the causes of small bowel perforation and To study the mortality and outcome of small bowel perforations. Results: In this study male preponderance was note with 68% of males and male to female ratio of 2.12:1. The commonest age group was 31 to 40 years (39%) and the mean age was 33.97 ± 13.93 years. Abdominal pain was the commonest presenting complaint (85%), dehydration was the common clinical sign (24%) and abdominal examination revealed tenderness in majority of the patients (86%). Single perforation was noted in 79% of the patients. The causes of the perforation were typhoid (38%), tuberculous perforation (22%) and non specific (27%). During post operative course blood transfusion was required in 15%, reversal in 14%, protein supplementation in 5% and amino acid transfusion in 3% of the patients while complications were present in 19% of the patients and majority of the patients had wound infection (94.74%). The mortality was noted in 4% of the patients. Age was significantly associated with causes of perforation (p=0.004) and ileocaecal perforation was associated with maximum complications (p<0.001). Conclusion: Non traumatic small bowel perforations are widely prevalent with infectious etiology that is, typhoid and tuberculosis. Early diagnosis and management result in favourable outcome among the patients with small bowel perforation.