Insight into the management of non-traumatic perforation of the small intestine.
BACKGROUND
Management of non-traumatic perforation of the small intestine has always been a consideration for surgeons because of associated enormous morbidity and mortality. There is a paucity of data on the management of non-traumatic perforation of the small intestine.


METHODS
A retrospective study was conducted which involved analysis of 192 patients treated for non-traumatic perforation of small intestine in a tertiary care teaching hospital in North India. The clinical profile and management of the patients were studied.


RESULTS
The most common cause of non-traumatic perforation of small intestine was typhoid (46.4%), followed by non-specific inflammation (39.2%), tuberculosis (12.8%) and malignant neoplasm (1.6%). Primary repair was the most frequent procedure (44.0%), followed by ileostomy (25.5%) and resection-anastomosis (19.3%). Superficial wound infection was the most frequent postoperative complication (46.8%), followed by wound dehiscence (31.3%). The wound infection rate was reduced significantly following delayed primary closure of skin incision. Enterocutaneous fistula/leak developed in 11.5% patients. Salvage ileostomy for post-operative intestinal leak resulted in a better survival rate as compared to conservative treatment (85.7% vs. 50.0%). The overall mortality rate was 16.6%.


CONCLUSIONS
Operative procedures undertaken for the management of non-traumatic perforation of small intestine can be classified into two groups: procedures that leave an intestinal suture line inside the peritoneal cavity and procedures that do not. The no suture line-in procedure seems to be better option in adverse patient conditions.
University College of Medical Sciences and GTB Hospital, University of Delhi, New Delhi, India. bhupendrakjain@gmail.com
Bhupendra Kumar
BK
Jain
Himanshu
H
Arora
Upendra Kumar
UK
Srivastava
Debajyoti
D
Mohanty
Pankaj Kumar
PK
Garg
D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D006784:Hospitals, Teaching; D006801:Humans; D007194:India; D007416:Intestinal Perforation / Q000175:diagnosis* / Q000601:surgery*; D007421:Intestine, Small / Q000473:pathology* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013530:Surgical Wound Infection / Q000453:epidemiology; D016896:Treatment Outcome; D055815:Young Adult