Clinical study and management of small bowel perforation in a tertiary care teaching institute

Abstract

Background: Small bowel perforation is one of the most common abdominal surgical emergencies encountered in present study region. Late presentation makes them a diagnostic and treatment dilemma. The aim of present study was to determine the age, sex, incidence, etiological factors, clinical features and various surgical procedures for small bowel perforations and its complications in the setup.Methods: Present study is a prospective observational study of 100 cases, conducted in a single teaching institute from October 2015 to December 2016. Various data such as presentation by the patient, age and sex incidence, etiologies, pathological features, morbidity and mortality associated with the causation and management were evaluated, tabulated and assessed. By analyzing the data, common etiologies of small bowel perforation, the most appropriate modality of investigation, treatment, and complications associated with different methods of management and possible ways to prevent them were studied.Results: Among all small bowel perforation, duodenal perforation (70%) was the commonest cause of small bowel perforation followed by ileal (23%) and jejunal (7%) perforations. The most common causes of ileal perforation was typhoid (47.8%) followed by tuberculosis (13%) and traumatic (13%). Overall mortality in small bowel perforation was 15%, with ileal perforation (39%) showing higher mortality rate than duodenal perforation (8.5%). Wound infection, toxaemia, uraemia, hypotension, and respiratory complications were common complications, more commonly noted in cases of ileal perforation.Conclusions: The study showed that effective pre-operative management with adequate fluid resuscitation, immediate operative intervention and good post-operative care led to better outcomes in these cases. Hence timely diagnosis and prompt management is the gold standard for favourable outcome in patients with small bowel perforation.