Nontraumatic ileal perforation : Surgical experience in rural population in indian scenario

Abstract

Objective: The purpose of our study was to review the clinical profile, etiology and optimal surgical management of patients with non traumatic ileal perforation. Methods: The study is an observative study carried out for the period of 4 years in the department of surgery. A total of 71 patients admitted through accident and emergency department and patients from medical wards admitted and treated with fever and diagnosed with peritonitis were included in the study. A written informed consent was obtained from each patient/ patient relative. Demographics, anthropometrics and clinical profiles were collected. Lab investigations, x-rays , ultrasound of abdomen and pelvis, operative findings, duration of hospital stay , post operative complications and mortality were recorded . Results: We have assessed and treated 71 cases of non traumatic ileal perforation; the causes for perforation were enteric fever [40(56.33%)], non specific inflammation[23(32.39%)],obstruction[ 7(9.85%)], tuberculosis[ 1(1.04%)] . The surgical procedures performed were simple/ primary closure (n=43), end to side ileotransverse anastomosis (n=2) primary ileostomy( n=6), and resection and end to end anastomosis (n=20). Conclusion: Terminal ileal perforation should be suspected in all cases of peritonitis especially in developing countries . Optimization of surgical techniques should be based on the etiology, delay in surgery and operative findings. Timely surgical intervention within 24 hours with adequate and aggressive resuscitation can decrease morbidity and mortality.