title: Surgery for small bowel perforation in an Asian population: predictors of morbidity and mortality.
abstract: BACKGROUND
  Peritonitis from small bowel perforation is associated with prohibitive morbidity and mortality rates. The aims of our study were to review our institution's experience in the surgical management of small bowel perforation and to identify factors that could predict morbidity and mortality.
  
  
  METHODS
  A retrospective review of all patients who underwent operative intervention for peritonitis from small bowel perforation from January 2003 to May 2008 was performed. Patients were identified from the hospital's diagnostic index and operating records. The severity of abdominal sepsis for all patients was graded using the Mannheim peritonitis index (MPI). All the complications were graded according to the classification proposed by Clavien and group.
  
  
  RESULTS
  Forty-seven patients, of median age 68 years (18-95 years), formed the study group. Pneumoperitoneum on chest radiographs was seen in only 11 (23.4%) patients. Foreign body ingestion (17.0%), adhesions (14.9%), and malignancy (12.8%) accounted for majority of the pathologies. There was one patient who had several small bowel perforations from Degos disease. Small bowel resection was performed in the majority of the patients (74.5%). The mortality rate in our series was 19.1%, while another 57.4% patients had perioperative complications. On univariate analysis, American Society of Anesthesiologists score >or= 3, MPI > 26, hypotension, stoma creation, abnormal electrolyte level, and renal impairment were related to worse outcome, while the three independent variables that were related to worse outcome after multivariate analysis were MPI > 26, hypotension, and abnormal serum potassium level.
  
  
  CONCLUSIONS
  Surgery for small bowel perforation is associated with significant morbidity and mortality rates. Patients with more severe peritonitis and physiological derangement were more likely to fare worse.
authors.affiliation: Department of General Surgery, Tan Tock Seng Hospital, Singapore, Singapore. kerkan@gmail.com
authors.forename: Ker-Kan
authors.initials: KK
authors.lastname: Tan
authors.forename: Shieh-Ling
authors.initials: SL
authors.lastname: Bang
authors.forename: Richard
authors.initials: R
authors.lastname: Sim
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000714:Anastomosis, Surgical / Q000379:methods / Q000401:mortality; D044466:Asian People / Q000706:statistics & numerical data; D002423:Cause of Death; D015331:Cohort Studies; D013505:Digestive System Surgical Procedures / Q000379:methods; D004638:Emergency Treatment; D005260:Female; D017052:Hospital Mortality / Q000639:trends*; D006801:Humans; D007416:Intestinal Perforation / Q000000981:diagnostic imaging / Q000401:mortality* / Q000601:surgery*; D007421:Intestine, Small / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010538:Peritonitis / Q000175:diagnosis / Q000401:mortality / Q000628:therapy; D011183:Postoperative Complications / Q000401:mortality; D011237:Predictive Value of Tests; D011336:Probability; D011379:Prognosis; D011859:Radiography; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D016019:Survival Analysis; D016896:Treatment Outcome; D055815:Young Adult